LOGAN SLACK

BEMIDJI, MN
NPI1982328480
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: MN  14888)
Additional Taxonomies363A00000X Physician Assistant
Enumeration Date2022-09-28
Last Update Date2024-05-20
Business Address
LOGAN SLACK
1300 ANNE ST NW
BEMIDJI, MN 56601-5103
Phone number: 218-751-9746
Mailing Address
LOGAN SLACK
PO BOX 5074
SIOUX FALLS, SD 57117-5074
Phone number: 605-328-9419
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