| Doctor Name: | LISA LOGELIN |
| NPI Number: | 1093133761 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 00540 |
| Business Practice Address: | 7945 Stone Creek Dr Suite 140 Chanhassen, MN - 553174605 |
| Business Phone Number: | 9529743999 |
| Business Fax Number: | 9529743780 |
| Mailing Address: | 1216 Crystal Pl E, CHASKA |
| State: | MN |
| Postal Code: | 553182233 |
| Phone Number: | 9522507697 |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2014 |
| NPI Last Update Date: | 03/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 00540 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |