Individual
LOGAN ROGER STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9038 CROSS PARK DR STE 105, KNOXVILLE, TN 37923-4729
(865) 394-6612
(865) 315-7014
Mailing address
9038 CROSS PARK DR STE 105, KNOXVILLE, TN 37923-4729
(865) 394-6612
(865) 315-7014
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-406163
TN
106S00000X
Behavior Technician
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Other
Enumeration date
06/22/2023
Last updated
01/27/2025
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