Provider Demographics
NPI:1679987010
Name:LOGAN, CARL (RF-HIS)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:LOGAN
Suffix:
Gender:M
Credentials:RF-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 WASHINGTON PIKE
Mailing Address - Street 2:SUITE A27
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2894
Mailing Address - Country:US
Mailing Address - Phone:412-564-5682
Mailing Address - Fax:412-564-5479
Practice Address - Street 1:1597 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2894
Practice Address - Country:US
Practice Address - Phone:412-564-5682
Practice Address - Fax:412-564-5479
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03431237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist