Provider Demographics
NPI:1285389239
Name:WARRINER, LOGAN MATTHEW
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:MATTHEW
Last Name:WARRINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ASHLEY ST APT 306
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2944
Mailing Address - Country:US
Mailing Address - Phone:425-753-0040
Mailing Address - Fax:
Practice Address - Street 1:1838 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3226
Practice Address - Country:US
Practice Address - Phone:360-972-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61124420106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61124420OtherWASHINGTON STATE DEPARTMENT OF HEALTH