Provider Demographics
NPI:1174825632
Name:LOGAN, LATOYA (LISW-S)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19612 GLADSTONE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6634
Mailing Address - Country:US
Mailing Address - Phone:216-751-0759
Mailing Address - Fax:
Practice Address - Street 1:23715 MERCANTILE RD
Practice Address - Street 2:SUITE 203A
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5933
Practice Address - Country:US
Practice Address - Phone:216-292-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical