MEDICARE: LOGAN VICTORIA ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	260506	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093443111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN VICTORIA ANDERSON

Provider Business Mailing Address
First Line	:	1299 FARNAM ST STE 300
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-1857
Country	:	US
Telephone Number	:	402-235-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	16726 PATRICK AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2545
Country	:	US
Telephone Number	:	402-686-5335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	03/10/2026

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Directions to “ LOGAN VICTORIA ANDERSON ” Practice Location

Language	Start Address	Practice Location

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