Provider Demographics
NPI:1952537763
Name:MCILWAIN, LOGAN C (LCSW)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:C
Last Name:MCILWAIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5820
Mailing Address - Country:US
Mailing Address - Phone:225-922-0040
Mailing Address - Fax:225-922-2707
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5820
Practice Address - Country:US
Practice Address - Phone:225-922-0040
Practice Address - Fax:225-922-2707
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker