Healthcare Provider Details

I. General information

NPI: 1518892728
Provider Name (Legal Business Name): LOGAN HICKS AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 180
VANCOUVER WA
98683-5518
US

IV. Provider business mailing address

1059 SE 24TH AVE
HILLSBORO OR
97123-7209
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax:
Mailing address:
  • Phone: 503-560-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCAAR.CG.70148750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: