Provider Demographics
NPI:1962155143
Name:LOGAN, ALLYSON JILL (CPM, LM)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JILL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:NH
Mailing Address - Zip Code:03602-8201
Mailing Address - Country:US
Mailing Address - Phone:603-477-6462
Mailing Address - Fax:
Practice Address - Street 1:18 THE SQ
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1380
Practice Address - Country:US
Practice Address - Phone:978-616-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0129917176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife