Provider Demographics
NPI:1649047077
Name:O'TOOLE, LOGAN ANNETTE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:ANNETTE
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:ANNETTE
Other - Last Name:O'TOOLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:8011 S CINNAMON RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6466
Mailing Address - Country:US
Mailing Address - Phone:605-271-1852
Mailing Address - Fax:
Practice Address - Street 1:8011 S CINNAMON RIDGE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6466
Practice Address - Country:US
Practice Address - Phone:605-271-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1210-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist