Provider Demographics
NPI:1831842046
Name:LOGGINS, KEANNA
Entity type:Individual
Prefix:
First Name:KEANNA
Middle Name:
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEANNA
Other - Middle Name:
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2915
Mailing Address - Country:US
Mailing Address - Phone:618-978-5805
Mailing Address - Fax:
Practice Address - Street 1:231 W LOCKWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2951
Practice Address - Country:US
Practice Address - Phone:314-968-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health