Provider Demographics
NPI:1255048948
Name:RICKER, LOGAN ANDREW (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:ANDREW
Last Name:RICKER
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8314
Mailing Address - Country:US
Mailing Address - Phone:423-736-8028
Mailing Address - Fax:
Practice Address - Street 1:900 TRADE ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5773
Practice Address - Country:US
Practice Address - Phone:423-254-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist