Provider Demographics
NPI:1124850342
Name:ROSS, LOGAN STEPHANIE (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:STEPHANIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SHERRILL DR
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9221
Mailing Address - Country:US
Mailing Address - Phone:717-476-2908
Mailing Address - Fax:
Practice Address - Street 1:122 SHERRILL DR
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9221
Practice Address - Country:US
Practice Address - Phone:717-476-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140754104100000X
MD32104104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker