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NPI Code Detail

MEDICARE: JENNA KALEEN LOGAN ACSW, SUDCC IV

MEDICARE: JENNA KALEEN LOGAN ACSW, SUDCC IV
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
11041C0700XClinical Social Worker98936CA
2101YA0400XAddiction (Substance Use Disorder) Counselor6079CA

General Provider Information

NPI Number : 1144597626
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA KALEEN LOGAN ACSW, SUDCC IV
Provider Business Mailing Address
First Line : 14275 RIOS CANYON RD UNIT 27
Second Line :
City : EL CAJON
State : CA
Zip : 92021-2778
Country : US
Telephone Number : 619-870-5456
Fax Number :
Provider Business Practice Location Address
First Line : 1400 N JOHNSON AVE STE 101
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1651
Country : US
Telephone Number : 619-442-0277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2011
Last Update Date : 03/16/2026

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