Logan Frederick Burgess
Specialist/Technologist, Speech-Language Assistant in Florissant, MO. Individual provider (NPI-1).
NPI number1649005331
StatusActive
Last updated in NPPESSep 3, 2024
Details
- NPI
- 1649005331
- Entity type
- Individual (NPI-1)
- Name
- Logan Frederick Burgess
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 3, 2024
- Certification date
- Sep 3, 2024
- Last updated
- Sep 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2355S0801X | Specialist/Technologist, Speech-Language Assistant | 2024016726 | MO | Yes |
Practice location
15600 Old Halls Ferry RdFlorissant, MO 63034-3385
Phone 314-953-4050
Mailing address
4093 Towbridge PlSwansea, IL 62226-8519
Phone 618-560-6521
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