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NPI Code Detail

MEDICARE: RUDY LOGAN

MEDICARE: RUDY LOGAN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1871440057
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUDY LOGAN
Provider Business Mailing Address
First Line : 1611 E HIDDEN VALLEY RD
Second Line :
City : SANDY
State : UT
Zip : 84092-5851
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12055 S 700 E
Second Line :
City : DRAPER
State : UT
Zip : 84020-9746
Country : US
Telephone Number : 801-980-7970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ RUDY LOGAN ” Practice Location

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