| Doctor Name: | MICHELLE MARIE LOGAN |
| NPI Number: | 1487753869 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CASAC |
| License Number: | 19014 |
| Business Practice Address: | 1062 State Route 38 Owego, NY - 13827 |
| Business Phone Number: | 6076874000 |
| Business Fax Number: | 6076876396 |
| Mailing Address: | 8 N. Chemung St., WAVERLY |
| State: | NY |
| Postal Code: | 14892 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 19014 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |