Provider Demographics
NPI:1245056787
Name:LOGSDON, MEGAN RENEE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14570 SW BONNIE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3615
Mailing Address - Country:US
Mailing Address - Phone:503-341-3979
Mailing Address - Fax:
Practice Address - Street 1:12725 SW MILLIKAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1687
Practice Address - Country:US
Practice Address - Phone:503-303-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR10403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor