Provider Demographics
NPI:1437393543
Name:LOGAN, STELLA JANE (CNS)
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:JANE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 STECK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8060
Mailing Address - Country:US
Mailing Address - Phone:512-476-3556
Mailing Address - Fax:512-476-0195
Practice Address - Street 1:3215 STECK AVE STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8060
Practice Address - Country:US
Practice Address - Phone:512-476-3556
Practice Address - Fax:512-476-0195
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX576725364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health