Provider Demographics
NPI:1346085933
Name:GOLIMBIESSKI, LOGAN JAMES
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JAMES
Last Name:GOLIMBIESSKI
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 1:4339 E ANNE ST
Mailing Address - Street 2:
Mailing Address - City:AU GRES
Mailing Address - State:MI
Mailing Address - Zip Code:48703-9640
Mailing Address - Country:US
Mailing Address - Phone:989-324-1557
Mailing Address - Fax:
Practice Address - Street 1:3227 DEEP RIVER RD.
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-718-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician