Individual
MS. LOGAN MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
1305 W WENDOVER AVE STE C, GREENSBORO, NC 27408-8100
(336) 541-8167
Mailing address
PO BOX 9804, GREENSBORO, NC 27429-0804
(336) 541-8167
(336) 294-8091
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14947
NC
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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