Healthcare Provider Details

I. General information

NPI: 1740878446
Provider Name (Legal Business Name): PAIGE ELIZABETH LOGAN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 201
LAFAYETTE LA
70508-3735
US

IV. Provider business mailing address

206 MONTREAL DR
LAFAYETTE LA
70507-4104
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0770
  • Fax: 337-534-4370
Mailing address:
  • Phone: 337-962-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16167
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: