Provider Demographics
NPI:1255079810
Name:LOGAR, TRACI L (SLPA)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:L
Last Name:LOGAR
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2698
Mailing Address - Country:US
Mailing Address - Phone:307-358-6187
Mailing Address - Fax:
Practice Address - Street 1:615 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2698
Practice Address - Country:US
Practice Address - Phone:307-358-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSLPA-0512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant