=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356574966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN SPEERS MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2009
-----------------------------------------------------
Last Update Date | 03/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5250 RALSTON ST
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-214-8562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 S MARIPOSA AVE #302
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-5461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-415-5053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 117179
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------