Provider Demographics
NPI:1699807214
Name:FERGUSON-LOGI, GINA (MS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FERGUSON-LOGI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:LOGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-2304
Practice Address - Street 1:901 HEMPHILL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3111
Practice Address - Country:US
Practice Address - Phone:817-332-4060
Practice Address - Fax:817-332-2304
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51244231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80331AOtherBLUE CROSS BLUE SHIELD
TX7910202OtherAETNA
TX7910202OtherAETNA