Healthcare Provider Details

I. General information

NPI: 1952248056
Provider Name (Legal Business Name): ADAM BENJAMIN LOGAN HCW,PSW,PCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 EWALD AVE SE
SALEM OR
97302-4710
US

IV. Provider business mailing address

313 EWALD AVE SE
SALEM OR
97302-4710
US

V. Phone/Fax

Practice location:
  • Phone: 971-331-1613
  • Fax:
Mailing address:
  • Phone: 971-331-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number820031
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number881621
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number844671
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: