Provider Demographics
NPI:1932836160
Name:LOGANS FOOTSTEPS PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:LOGANS FOOTSTEPS PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, M ED, LBA
Authorized Official - Phone:586-214-6898
Mailing Address - Street 1:23630 HOLLWEG ST
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-4601
Mailing Address - Country:US
Mailing Address - Phone:586-214-6898
Mailing Address - Fax:
Practice Address - Street 1:23630 HOLLWEG ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-4601
Practice Address - Country:US
Practice Address - Phone:586-214-6898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty