Individual
KATHLEEN M LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
555 E BROADWAY AVE STE 204, JACKSON, WY 83001-8640
(307) 739-4818
(888) 329-5701
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-4818
(888) 329-5701
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11343A
WY
2084P0800X
Psychiatry Physician
25358
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150491600
—
WY
Enumeration date
12/27/2005
Last updated
02/10/2021
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