Provider Demographics
NPI:1063871481
Name:LOGG, AKI (CGC)
Entity type:Individual
Prefix:
First Name:AKI
Middle Name:
Last Name:LOGG
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3651
Mailing Address - Country:US
Mailing Address - Phone:626-381-5975
Mailing Address - Fax:626-564-3311
Practice Address - Street 1:74 N PASADENA AVE FL 8
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3670
Practice Address - Country:US
Practice Address - Phone:626-381-5975
Practice Address - Fax:626-564-3311
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000077170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS