Individual
SALLY LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 671-0619
Mailing address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 671-0619
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/12/2012
Last updated
02/04/2013
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