Provider Demographics
NPI:1811769888
Name:LOGSDON, SIERRA JOY
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:JOY
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:ALLEN
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:407 W. SOUTH AVE.
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-6133
Mailing Address - Country:US
Mailing Address - Phone:580-749-5056
Mailing Address - Fax:580-215-5756
Practice Address - Street 1:407 W. SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-6133
Practice Address - Country:US
Practice Address - Phone:580-749-5056
Practice Address - Fax:580-215-5756
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator