Individual
LOGAN J. ELLOWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSED
Contact information
Practice address
4646 W JEFFERSON BLVD STE 100, FORT WAYNE, IN 46804-6832
(260) 436-0932
(260) 436-1185
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35002104A
IN
Other
Enumeration date
06/05/2017
Last updated
06/16/2020
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