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Individual

MRS. KATIE DEAN LOGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CTRS/L

Contact information

Practice address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(844) 458-2100
Mailing address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(844) 458-2100

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
166
OK

Other

Enumeration date
07/09/2022
Last updated
07/09/2022
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