Provider Demographics
NPI:1558874222
Name:LOGAN, LAURA DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DAWN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FULWEILER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4536
Mailing Address - Country:US
Mailing Address - Phone:530-889-4060
Mailing Address - Fax:
Practice Address - Street 1:145 FULWEILER AVE STE 200
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4536
Practice Address - Country:US
Practice Address - Phone:530-889-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1188501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical