Provider Demographics
NPI:1871847897
Name:LOGAN, JENNIFER MONETTE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MONETTE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 W DARK SKY ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5096
Mailing Address - Country:US
Mailing Address - Phone:805-870-5715
Mailing Address - Fax:
Practice Address - Street 1:3038 W DARK SKY ST
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5096
Practice Address - Country:US
Practice Address - Phone:805-870-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist