MEDICARE: CARA LOGAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8819051-3501	UT

General Provider Information

NPI Number	:	1063892339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA LOGAN LCSW

Provider Business Mailing Address
First Line	:	1664 S DIXIE DR
Second Line	:	C-102
City	:	ST GEORGE
State	:	UT
Zip	:	84770-7327
Country	:	US
Telephone Number	:	435-673-4494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 S DIXIE DR
Second Line	:	C-102
City	:	ST GEORGE
State	:	UT
Zip	:	84770-7327
Country	:	US
Telephone Number	:	435-673-4494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	08/25/2015

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Directions to “ CARA LOGAN LCSW” Practice Location

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