Provider Demographics
NPI:1730974130
Name:LOGGINS, KATHERINE LATIFAH
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LATIFAH
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W ONEIL DR APT 1145
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1195
Mailing Address - Country:US
Mailing Address - Phone:520-414-6031
Mailing Address - Fax:
Practice Address - Street 1:720 W ONEIL DR APT 1145
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1195
Practice Address - Country:US
Practice Address - Phone:520-414-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-22-236087106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician