Healthcare Provider Details

I. General information

NPI: 1205704525
Provider Name (Legal Business Name): LOGAN EMILY VONHEEDER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MAIN ST
DERBY LINE VT
05830-8754
US

IV. Provider business mailing address

2551 VT ROUTE 105 APT C
NEWPORT CENTER VT
05857-9701
US

V. Phone/Fax

Practice location:
  • Phone: 802-673-4466
  • Fax:
Mailing address:
  • Phone: 802-673-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number097.0136563
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: