Provider Demographics
NPI:1861268096
Name:LOGAN, JAKARD (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JAKARD
Middle Name:
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 PREWITT RANCH RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2010
Mailing Address - Country:US
Mailing Address - Phone:785-317-4236
Mailing Address - Fax:
Practice Address - Street 1:6410 MORGANITE LN
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3902
Practice Address - Country:US
Practice Address - Phone:254-336-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist