Provider Demographics
NPI:1932441607
Name:LOGVINENKO, ELENA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LOGVINENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 SW OAK ST STE 404
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2807
Mailing Address - Country:US
Mailing Address - Phone:503-658-9635
Mailing Address - Fax:503-825-0059
Practice Address - Street 1:917 SW OAK ST STE 404
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2807
Practice Address - Country:US
Practice Address - Phone:503-658-9635
Practice Address - Fax:503-825-0059
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1821962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry