Most Relevant Information
Provider Data
| NPI Number: | 1003013491 |
| Provider Name: | KENNETH ALAN LOGAN PSY.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | PSY21249 |
Most Important Dates
| Enumeration Date: | 06/28/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1891 E ROSEVILLE PKWY
SUITE 100
ROSEVILLE
CA
956617973
Practice Location Phone/Fax
| Phone: | 9167897082 |
| Fax: | 9167978840 |
Provider Mailing Location
1891 E ROSEVILLE PKWY
SUITE 100
ROSEVILLE
CA
956617973
Provider Mailing Phone/Fax
| Phone: | 9167897082 |
| Fax: | 9167978840 |