Emily Noel Logan

Key facts

NPI

1548867211

Entity type

Individual (NPI type 1)

Primary specialty

Community Health Worker 172V00000X

Practice address

1797 San Jose Ave
Clovis, CA 93611-3078

Phone

(559) 790-2394

NPI assigned

Oct 6, 2020

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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.

• 2ND Home Incorporated Mental Illness Community Based Residential Treatment Facility · Clovis, CA · NPI 1730716952
  NPD
• 2ND Home Incorporated Mental Illness Community Based Residential Treatment Facility · Fresno, CA · NPI 1346877594
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2024.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1548867211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1797 SAN JOSE AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936113078",
            "telephone_number": "559-790-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1797 SAN JOSE AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936113078",
            "telephone_number": "559-790-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "EMILY",
        "middle_name": "NOEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-06",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Clovis, CA · Community Health Worker in California