Provider Demographics
NPI:1790355220
Name:LOGAN, DANNIELLE
Entity Type:Individual
Prefix:
First Name:DANNIELLE
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 1:317 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1309
Mailing Address - Country:US
Mailing Address - Phone:724-919-2758
Mailing Address - Fax:
Practice Address - Street 1:2858 FREEPORT RD STE A
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1970
Practice Address - Country:US
Practice Address - Phone:724-919-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty