Healthcare Provider Details

I. General information

NPI: 1740172204
Provider Name (Legal Business Name): LOGAN DARROW BURKHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD
SAINT LOUIS MO
63122-7254
US

IV. Provider business mailing address

1305 FAWNVALLEY DR
DES PERES MO
63131-4206
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone: 314-556-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2025023004
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: