MEDICARE: LOGAN CRAIG KNOWLTON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1487394243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN CRAIG KNOWLTON

Provider Business Mailing Address
First Line	:	PO BOX 740780
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0780
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 N DUTTON AVE STE 140
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4652
Country	:	US
Telephone Number	:	707-435-3080
Fax Number	:

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

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/24/2026

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Directions to “ LOGAN CRAIG KNOWLTON ” Practice Location

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