Healthcare Provider Details

I. General information

NPI: 1881508299
Provider Name (Legal Business Name): JENNIFER ASHLEY LOGAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LOGAN LLMSW

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 KENSINGTON ST
DEXTER MI
48130-1341
US

IV. Provider business mailing address

3060 KENSINGTON ST
DEXTER MI
48130-1341
US

V. Phone/Fax

Practice location:
  • Phone: 734-424-4140
  • Fax:
Mailing address:
  • Phone: 734-424-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851121628
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: