Dustin M Logan, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

121536 Issued in AK

Practice address

8201 N Michaelson St
Palmer, AK 99645-8196

Phone

(907) 745-5066

Fax

(877) 640-1413

NPI assigned

Jan 24, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Neurobehavior North, Inc.

  • Clinical Neuropsychologist
  • Palmer, AK
  • NPI 1457621914
  Medicare reassignment NPD

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1851578512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3034",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996453034",
            "telephone_number": "907-745-5066",
            "fax_number": "907-746-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 N MICHAELSON ST",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996458196",
            "telephone_number": "907-745-5066",
            "fax_number": "877-640-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "DUSTIN",
        "middle_name": "M",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "60616291",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AK",
            "license": "121536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Locke, MFT-A
• Lodestar Family Eye Care, PC
• Ann Marie Lofgreen
• Paula Loftis
• Darcy Grover Logan
• Leah Marie Lonegan, RBT
• Grace M Long, PH.D.
• Haidyn Mackenzie Long, MA CMHC
• Angelina R Lopez
• Ariana L Lopez

• Clinical Neuropsychologist in Palmer, AK
• Providers in Palmer, AK by specialty
• Clinical Neuropsychologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.