Individual
MARY-OLIETA MICHELLE LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 SMELTER AVE NE, GREAT FALLS, MT 59404-1937
(406) 452-9531
Mailing address
215 SMELTER AVE NE, GREAT FALLS, MT 59404-1937
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-51515
MT
Other
Enumeration date
05/02/2018
Last updated
06/16/2018
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