| Logan Community Resources | |
|
2505 E Jefferson Blvd South Bend IN 46615-2635 | |
| (574) 289-4831 | |
| (574) 234-2075 |
| Full Name | Logan Community Resources |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2505 E Jefferson Blvd, South Bend, Indiana |
| Authorized Official Name and Position | Dan Ryan (DIR SONYA ANSARI CENTER FOR AUTISM) |
| Authorized Official Contact | 5742894831 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Community Resources 2505 E Jefferson Blvd South Bend IN 46615-2635 Ph: (574) 289-4831 | Logan Community Resources 2505 E Jefferson Blvd South Bend IN 46615-2635 Ph: (574) 289-4831 |
| NPI Number | 1639558331 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 05/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639558331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-15-18324 (Indiana) | Primary |
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