Provider Demographics
NPI:1962644757
Name:KEYSER, LOGAN KENDRICK
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:KENDRICK
Last Name:KEYSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5508
Mailing Address - Country:US
Mailing Address - Phone:530-894-8008
Mailing Address - Fax:530-872-7784
Practice Address - Street 1:130 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5508
Practice Address - Country:US
Practice Address - Phone:530-894-8008
Practice Address - Fax:530-872-7784
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor