MEDICARE: BONNIE L LOGAN MSW

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

General Provider Information

NPI Number	:	1942692074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE L LOGAN MSW

Provider Business Mailing Address
First Line	:	1404 RACE ST
Second Line	:	SUITE 302
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7297
Country	:	US
Telephone Number	:	859-991-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 RACE ST
Second Line	:	SUITE 302
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7297
Country	:	US
Telephone Number	:	859-991-2846
Fax Number	:

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	03/12/2015

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