Provider Demographics
NPI:1598550337
Name:WADDELL, LOGAN FORREST
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:FORREST
Last Name:WADDELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 WOODLING WAY
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9253
Mailing Address - Country:US
Mailing Address - Phone:330-608-7642
Mailing Address - Fax:
Practice Address - Street 1:4389 MEDINA RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1388
Practice Address - Country:US
Practice Address - Phone:234-815-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital