Provider Demographics
NPI:1710119649
Name:HORNER, LOGAN (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:HORNER
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2693
Mailing Address - Country:US
Mailing Address - Phone:210-824-0632
Mailing Address - Fax:210-824-8514
Practice Address - Street 1:603 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2693
Practice Address - Country:US
Practice Address - Phone:210-824-0632
Practice Address - Fax:210-824-8514
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80180237700000X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710119649Medicaid
TX80180OtherSTATE BOARD