Healthcare Provider Details

I. General information

NPI: 1447184916
Provider Name (Legal Business Name): SYDNEY LOGEAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 37TH AVE S STE 200
MOORHEAD MN
56560-5524
US

IV. Provider business mailing address

815 37TH AVE S STE 200
MOORHEAD MN
56560-5524
US

V. Phone/Fax

Practice location:
  • Phone: 701-471-7092
  • Fax: 701-401-0267
Mailing address:
  • Phone: 701-471-7092
  • Fax: 701-401-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: