Individual
LOGAN LEE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN LDN
Contact information
Practice address
2872 TURNPIKE ST, SUSQUEHANNA, PA 18847-2771
(570) 853-3135
Mailing address
176 GREEN VALLEY RD, HALLSTEAD, PA 18822-9544
(607) 372-5336
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86105199
PA
Other
Enumeration date
03/13/2022
Last updated
03/20/2022
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