MEDICARE: DR. ELLEN UDINE LOGACZ PH.D. LP MA LMFT

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	103T00000X	Psychologist	LP4107	MN
2	106H00000X	Marriage & Family Therapist	909	MN

General Provider Information

NPI Number	:	1538382767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN UDINE LOGACZ PH.D. LP MA LMFT

Provider Business Mailing Address
First Line	:	5441 BRYANT AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1737
Country	:	US
Telephone Number	:	612-824-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 DUPONT AVE S
Second Line	:	SUITE 301
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2700
Country	:	US
Telephone Number	:	612-824-9528
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	09/11/2025

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