Provider Demographics
NPI:1588958268
Name:LOGAN, ANGELA LEE (LSCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 THOMAS CT STE A-2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5403
Mailing Address - Country:US
Mailing Address - Phone:785-550-4606
Mailing Address - Fax:
Practice Address - Street 1:3600 THOMAS CT STE A-2
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5403
Practice Address - Country:US
Practice Address - Phone:785-550-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS061741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical