Healthcare Provider Details

I. General information

NPI: 1790355220
Provider Name (Legal Business Name): DANNIELLE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 01/19/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 FREEPORT RD STE A
NATRONA HEIGHTS PA
15065-1970
US

IV. Provider business mailing address

317 GRANT AVE
LEECHBURG PA
15656-1309
US

V. Phone/Fax

Practice location:
  • Phone: 724-919-2758
  • Fax:
Mailing address:
  • Phone: 724-919-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: