Provider Demographics
NPI:1902279797
Name:LOGAN, EMILY SARA (LISW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SARA
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 SPRING MEADOW PL NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-6663
Mailing Address - Country:US
Mailing Address - Phone:319-389-2360
Mailing Address - Fax:
Practice Address - Street 1:1785 CURTIS BRIDGE ROAD NE
Practice Address - Street 2:OKERBERG AND ASSOCIATES
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-665-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical