MEDICARE: MS. ADRIENNE LOGAN LMSW

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	104100000X	Social Worker	107905	TX

General Provider Information

NPI Number	:	1124743190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADRIENNE LOGAN LMSW

Provider Business Mailing Address
First Line	:	5750 PINELAND DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-9242
Country	:	US
Telephone Number	:	214-221-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	8515 GREENVILLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-7011
Country	:	US
Telephone Number	:	214-221-0855
Fax Number	:

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

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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Directions to “ MS. ADRIENNE LOGAN LMSW” Practice Location

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