Provider Demographics
NPI:1023446275
Name:LOGANBILL, JENNIFER LYNNE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:LOGANBILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 R AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2276
Mailing Address - Country:US
Mailing Address - Phone:360-770-7325
Mailing Address - Fax:360-299-4070
Practice Address - Street 1:1601 R AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2276
Practice Address - Country:US
Practice Address - Phone:360-770-7325
Practice Address - Fax:360-299-4070
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603432291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6034229Medicaid