Provider Demographics
NPI:1487320925
Name:LOGAN, PHILADELPHIA MARGRET (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PHILADELPHIA
Middle Name:MARGRET
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DELLA
Other - Middle Name:
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:8693 ELK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1550
Mailing Address - Country:US
Mailing Address - Phone:209-277-1654
Mailing Address - Fax:
Practice Address - Street 1:555 OAKDALE ST STE E
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2451
Practice Address - Country:US
Practice Address - Phone:916-790-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist