Provider Demographics
NPI:1538382767
Name:LOGACZ, ELLEN UDINE (PHD LP MA LMFT)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:UDINE
Last Name:LOGACZ
Suffix:
Gender:F
Credentials:PHD LP MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1737
Mailing Address - Country:US
Mailing Address - Phone:612-824-9528
Mailing Address - Fax:
Practice Address - Street 1:2124 DUPONT AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2700
Practice Address - Country:US
Practice Address - Phone:612-824-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4107103T00000X
MN909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist