Individual
LOGAN JADE GASKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1777 AXTELL DR STE 100, TROY, MI 48084-4400
(248) 613-5377
Mailing address
19188 SOUTHAMPTON DR, LIVONIA, MI 48152-4106
(248) 444-3250
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301018085
MI
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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