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General NPI Number Information
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NPI Number | 1700763000
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Entity Type | Individual
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Provider Name | LOGAN SCOTT WIERSCHKE T-LMHC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 212 W DALE ST # 100
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City | WATERLOO
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State | IA
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Zip | 50703-1954
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Country | US
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Telephone | 319-235-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 297 FAST LN
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City | CEDAR FALLS
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State | IA
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Zip | 50613-2174
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Country | US
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Telephone | 515-491-1994
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 133843
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License Number State | IA
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