Provider Demographics
NPI:1487941852
Name:LOGAN, JACQUELINE ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROSE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:1500 OXFORD DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1823
Mailing Address - Country:US
Mailing Address - Phone:412-692-5011
Mailing Address - Fax:412-851-1750
Practice Address - Street 1:1500 OXFORD DR
Practice Address - Street 2:SUITE 10
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1823
Practice Address - Country:US
Practice Address - Phone:412-692-5011
Practice Address - Fax:412-851-1750
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASL009511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist