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General NPI Number Information
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NPI Number | 1760908263
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Entity Type | Individual
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Provider Name | LOGAN OLIVIA WILDER-INGRAM
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1910 FAIRGROVE AVE
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City | HAMILTON
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State | OH
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Zip | 45011-1930
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Country | US
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Telephone | 513-494-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 FAIRGROVE AVE
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City | HAMILTON
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State | OH
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Zip | 45011-1930
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Country | US
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Telephone | 513-494-4679
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2505581
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.161933
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2204204
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2204204
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.167891
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162260
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.164220
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License Number State | OH
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