Kenneth Alan Logan, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY21249 Issued in CA

Practice address

1891 E Roseville Pkwy
Suite 100
Roseville, CA 95661-7973

Phone

(916) 789-7082

Fax

(916) 797-8840

NPI assigned

Jun 28, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenneth L. Larson, PH.D., Inc.

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1609396183
  NPD (past)
• Travis H. Owens, Psy.D. Inc.

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1275762452
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003013491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617973",
            "telephone_number": "916-789-7082",
            "fax_number": "916-797-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617973",
            "telephone_number": "916-789-7082",
            "fax_number": "916-797-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "KENNETH",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chay Lo, PHARMD
• Keras Lo, PHARM D
• Keia Destiny Lockwood
• Tiffany Loeffler, DPT
• Julie Sladek Loewen, M.D.
• Joseph Nicholas Logarbo, MD
• Genevieve A Logie, MD
• Travis Loidolt, DO
• Ryan James Lokkesmoe
• Jamie Lee Lombrana, MFT TRAINEE

• Clinical Psychologist in Roseville, CA
• Providers in Roseville, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.