Individual
MR. AHMAD KEENAN TAJ LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1622 BARTOW RD, MCKINLEYVILLE, CA 95519-4309
(925) 497-6601
Mailing address
1622 BARTOW RD, MCKINLEYVILLE, CA 95519-4309
(925) 497-6601
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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