Provider Demographics
NPI:1023786035
Name:COLLIN, LOGANN DALE
Entity type:Individual
Prefix:
First Name:LOGANN
Middle Name:DALE
Last Name:COLLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOGANN
Other - Middle Name:DALE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-6503
Mailing Address - Country:US
Mailing Address - Phone:308-870-6281
Mailing Address - Fax:
Practice Address - Street 1:915 16TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-6503
Practice Address - Country:US
Practice Address - Phone:308-870-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE127311041S0200X
NE76531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical