Active NPI
Gregory David Logan, M.S., SLP
- Speech-Language Pathologist
- Whitefish, MT
National Provider Identifier
1205972171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1194
- Practice address
- 219 Minnesota Ave
Whitefish, MT 59937-2347 - Phone
- (407) 270-1949
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP653 | ME | |
| Speech-Language Pathologist | 235Z00000X | 1194 | MT | Primary |
Addresses
Primary practice location
219 Minnesota Ave
Whitefish, MT 59937-2347
Mailing address
PO Box 5236
Whitefish, MT 59937-5236
Phone (406) 270-1949
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008640 | Other | ME | ANTHEM BCBS |
| 300740099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP653 | ME | MD | Speech-Language Pathologist |
| 1194 | MT | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311033600000",
"number": "1205972171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5236",
"city": "WHITEFISH",
"state": "MT",
"postal_code": "599375236",
"telephone_number": "406-270-1949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 MINNESOTA AVE",
"city": "WHITEFISH",
"state": "MT",
"postal_code": "599372347",
"telephone_number": "407-270-1949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "GREGORY",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "M.S., SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2011-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ME",
"license": "SP653",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MT",
"license": "1194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "008640",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300740099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whitefish, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.