Individual
LOGAN OLIVIA WILDER-INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 FAIRGROVE AVE, HAMILTON, OH 45011-1930
(513) 494-4679
Mailing address
1910 FAIRGROVE AVE, HAMILTON, OH 45011-1930
(513) 494-4679
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.164220
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.167891
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.161933
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.162260
OH
101YM0800X
Mental Health Counselor
C.2204204
OH
101YP2500X
Professional Counselor
Primary
E.2505581
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0443789
—
OH
Enumeration date
08/16/2017
Last updated
10/20/2025
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