Provider Demographics
NPI:1922511831
Name:LOGAN, KARISSA (ND, EAMP)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:ND, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 105TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4629
Mailing Address - Country:US
Mailing Address - Phone:425-622-7567
Mailing Address - Fax:
Practice Address - Street 1:5414 BARNES AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3839
Practice Address - Country:US
Practice Address - Phone:425-610-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60529661171100000X
WANT60955458175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist