Provider Demographics
NPI:1487871539
Name:LOGSDON, REBECCA G (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 3RD AVE NE STE 507
Mailing Address - Street 2:BOX 358733
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2053
Mailing Address - Country:US
Mailing Address - Phone:206-685-1758
Mailing Address - Fax:206-616-5588
Practice Address - Street 1:9709 3RD AVE NE STE 507
Practice Address - Street 2:BOX 358733
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2053
Practice Address - Country:US
Practice Address - Phone:206-685-1758
Practice Address - Fax:206-616-5588
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical