Healthcare Provider Details

I. General information

NPI: 1487558169
Provider Name (Legal Business Name): LOGAN HARVEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7916 SE FOSTER RD STE 201
PORTLAND OR
97206-4289
US

IV. Provider business mailing address

PO BOX 16576
PORTLAND OR
97292-0576
US

V. Phone/Fax

Practice location:
  • Phone: 503-465-2749
  • Fax:
Mailing address:
  • Phone: 503-465-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: