Provider Demographics
NPI:1902588577
Name:NEAL, LOGAN JACOB (RRT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:JACOB
Last Name:NEAL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 N MAYFAIR ST APT 27
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5967
Mailing Address - Country:US
Mailing Address - Phone:509-714-6063
Mailing Address - Fax:
Practice Address - Street 1:8506 N MAYFAIR ST APT 27
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5967
Practice Address - Country:US
Practice Address - Phone:509-714-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR15958602227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered