MR. Logan Mchael Southwell

NPI #1851146229 in Shawnee, Oklahoma

Provider Information

NPI Number: 1851146229
Entity Type: Individual
Name: MR. Logan Mchael Southwell
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Apr 19, 2024
Last Updated: Apr 19, 2024

Practice Location

Address: 1601 GORDON COOPER DR
City: Shawnee
State: Oklahoma
ZIP Code: 74801-9002
Phone: (405) 878-3854

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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