Individual
MAKENZIE RAE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 HIGH SCHOOL DR, BELLEVUE, NE 68005-3274
(402) 293-4150
Mailing address
2600 ARBORETUM DR, BELLEVUE, NE 68005-3501
(402) 293-4000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2018010907
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TFZ826226512
BLUECROSS BLUESHIELD OF ILLINOIS
IL
Enumeration date
08/13/2018
Last updated
08/13/2018
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