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NPI Code Detail

MEDICARE: ALICIA J LOGAN MHRS

MEDICARE:   ALICIA J LOGAN  MHRS
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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator
3172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1629210877
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA J LOGAN MHRS
Provider Business Mailing Address
First Line : PO BOX 2077
Second Line :
City : UKIAH
State : CA
Zip : 95482-2077
Country : US
Telephone Number : 707-472-2922
Fax Number :
Provider Business Practice Location Address
First Line : 531 S ORCHARD AVE STE A
Second Line :
City : UKIAH
State : CA
Zip : 95482-5022
Country : US
Telephone Number : 707-472-2922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 09/02/2025

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