Provider Demographics
NPI:1356574966
Name:SPEERS, LOGAN (MSW)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:SPEERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S MARIPOSA AVE
Mailing Address - Street 2:#302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5461
Mailing Address - Country:US
Mailing Address - Phone:805-415-5053
Mailing Address - Fax:
Practice Address - Street 1:5250 RALSTON ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7318
Practice Address - Country:US
Practice Address - Phone:424-214-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117179104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker