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General NPI Number Information
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NPI Number | 1407746225
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Entity Type | Individual
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Provider Name | LOGAN R GROOMS BA
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Gender | Female
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 34 BARRE ST
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City | MONTPELIER
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State | VT
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Zip | 05602-3510
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Country | US
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Telephone | 802-301-3200
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Fax | 802-223-0842
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Provider Business Mailing Address
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Address Line | PO BOX 647
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City | MONTPELIER
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State | VT
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Zip | 05601-0647
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Country | US
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Telephone | 802-301-3200
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Fax | 802-223-0842
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 097.0136531
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License Number State | VT
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