Provider Demographics
NPI:1720185473
Name:LOGSDON, JESSICA L (MHS, MHA, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:MHS, MHA, PA-C
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HUARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:CA 463
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:CA 463
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant