Individual
LOGAN FREDERICK BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15600 OLD HALLS FERRY RD, FLORISSANT, MO 63034-3385
(314) 953-4050
Mailing address
4093 TOWBRIDGE PL, SWANSEA, IL 62226-8519
(618) 560-6521
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
2024016726
MO
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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