Provider Demographics
NPI:1942599691
Name:LOGAN, JAMIE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 ROY WEBB RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-7412
Mailing Address - Country:US
Mailing Address - Phone:256-447-9349
Mailing Address - Fax:256-447-8660
Practice Address - Street 1:6344 ROY WEBB RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-7412
Practice Address - Country:US
Practice Address - Phone:256-447-9349
Practice Address - Fax:256-447-8660
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-1592103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst