MEDICARE: ANN LOGAN PHD

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	103T00000X	Psychologist	726	WV

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	:	1568461168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN LOGAN PHD

Provider Business Mailing Address
First Line	:	823 MADISON AVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-6723
Country	:	US
Telephone Number	:	304-322-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 MADISON AVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-6723
Country	:	US
Telephone Number	:	304-322-9922
Fax Number	:	831-708-2797

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/21/2023

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Directions to “ ANN LOGAN PHD” Practice Location

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