Provider Demographics
NPI:1063584431
Name:LOGAN, ISABEALL TALMADGE (PHD)
Entity type:Individual
Prefix:DR
First Name:ISABEALL
Middle Name:TALMADGE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 ROUTE 7 S
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8806
Mailing Address - Country:US
Mailing Address - Phone:802-377-2852
Mailing Address - Fax:
Practice Address - Street 1:89 MAIN ST.
Practice Address - Street 2:COUNSELING SERVICE OF ADDISON COUNTY
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8806
Practice Address - Country:US
Practice Address - Phone:802-377-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0066611101YM0800X
MALMHC 5183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health