Healthcare Provider Details

I. General information

NPI: 1477714830
Provider Name (Legal Business Name): LOGAN K. WINK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/25/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 RED BANK RD STE 212
CINCINNATI OH
45227-1509
US

IV. Provider business mailing address

4790 RED BANK RD STE 212
CINCINNATI OH
45227-1509
US

V. Phone/Fax

Practice location:
  • Phone: 513-906-5476
  • Fax: 513-283-0163
Mailing address:
  • Phone: 513-906-5476
  • Fax: 513-283-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39099507
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number52856
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.099507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: