Individual
WANDA COOK LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RT,R DMS
Contact information
Practice address
5111 SAULK TRAIL, RICHTON PARK, IL 60471
(219) 836-4702
(219) 841-7004
Mailing address
19753 OAKWOOD AVE, LYNWOOD, IL 60411-6333
(708) 250-7108
(219) 841-7004
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
156765
IL
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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