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NPI Code Detail

MEDICARE: LOGAN RYAN AIELLO

MEDICARE: LOGAN RYAN AIELLO
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 TechnicianRBT-26-541561MO

General Provider Information

NPI Number : 1992638365
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN RYAN AIELLO
Provider Business Mailing Address
First Line : 116 W SHERMAN WAY STE 1
Second Line :
City : NIXA
State : MO
Zip : 65714-9022
Country : US
Telephone Number : 417-298-0984
Fax Number : 417-374-7185
Provider Business Practice Location Address
First Line : 116 W SHERMAN WAY STE 1
Second Line :
City : NIXA
State : MO
Zip : 65714-9022
Country : US
Telephone Number : 417-298-0984
Fax Number : 417-374-7185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ LOGAN RYAN AIELLO ” Practice Location

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