Provider Demographics
NPI:1548816879
Name:PATZLAFF, LOGAN JAMES
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JAMES
Last Name:PATZLAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45360 SW ETTERS RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-9074
Mailing Address - Country:US
Mailing Address - Phone:503-858-2185
Mailing Address - Fax:
Practice Address - Street 1:6200 SW ARTIC DRIVE BEAVERTON, OR 97005
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-224-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician