Individual
AMANDA LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
1202 WESTRAC DR S, SUITE 400, FARGO, ND 58103-2338
(107) 280-9545
(701) 280-9520
Mailing address
1202 WESTRAC DR S, SUITE 400, FARGO, ND 58103-2338
(107) 280-9545
(701) 280-9520
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
16371
MN
104100000X
Social Worker
4408
ND
1041C0700X
Clinical Social Worker
Primary
4408
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1465561
—
ND
Enumeration date
10/02/2015
Last updated
11/02/2017
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