Individual
KIKI LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
245 E PARK RD, ELLENBORO, NC 28040-7621
(828) 305-3870
Mailing address
245 E PARK RD, ELLENBORO, NC 28040-7621
(828) 305-3870
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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