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General NPI Number Information
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NPI Number | 1063871481
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Entity Type | Individual
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Provider Name | AKI LOGG CGC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 74 N PASADENA AVE FL 8
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City | PASADENA
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State | CA
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Zip | 91103-3670
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Country | US
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Telephone | 626-381-5975
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Fax | 626-564-3311
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Provider Business Mailing Address
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Address Line | 75 N FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91103-3651
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Country | US
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Telephone | 626-381-5975
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Fax | 626-564-3311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC000077
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License Number State | CA
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