Provider Demographics
NPI:1619386273
Name:LOGAN, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S G ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4715
Mailing Address - Country:US
Mailing Address - Phone:253-448-0828
Mailing Address - Fax:
Practice Address - Street 1:519 S G ST
Practice Address - Street 2:SUITE 6
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4715
Practice Address - Country:US
Practice Address - Phone:253-448-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health