Individual
MR. GREGORY DAVID LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., SLP
Contact information
Practice address
219 MINNESOTA AVE, WHITEFISH, MT 59937-2347
(407) 270-1949
Mailing address
PO BOX 5236, WHITEFISH, MT 59937-5236
(406) 270-1949
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1194
MT
235Z00000X
Speech-Language Pathologist
SP653
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008640
ANTHEM BCBS
ME
05
—
300740099
—
ME
Enumeration date
01/29/2007
Last updated
07/19/2011
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