Individual
JESSICA LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
89-195 FARRINGTON HWY, WAIANAE, HI 96792-4102
(808) 696-7657
Mailing address
1019A 8TH AVE, HONOLULU, HI 96816-2490
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
1950
HI
1041C0700X
Clinical Social Worker
Primary
3903
HI
Other
Enumeration date
11/15/2011
Last updated
04/28/2014
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