Provider Demographics
NPI:1952972846
Name:LOGSDON, JASON WILLIAM (LMSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WILLIAM
Last Name:LOGSDON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11927 PERLA JOY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7320
Mailing Address - Country:US
Mailing Address - Phone:512-954-7276
Mailing Address - Fax:
Practice Address - Street 1:3635 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-4042
Practice Address - Country:US
Practice Address - Phone:210-262-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104846104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker