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Logan Olivia Wilder-Ingram

Counselor - Professional β€’ Hamilton, OH

Active NPI 1760908263 Individual Practitioner Female Practitioner Accepts Medicare assignment
Practice location in NPPES

1910 Fairgrove Ave
Hamilton, OH 450111930

Call 5134944679 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

1910 Fairgrove Ave

Hamilton, OH 450111930

Telephone 5134944679
Organization at the Same NPPES Address or Phone
Catholic Charities Of Southwestern Ohio Facility NPI 1659304129

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

CMS Doctors and Clinicians lists 1 group name: Modern Psychiatry And Wellness Llc. See the list

Source: CMS Doctors and Clinicians National Downloadable File, CMS release of October 2, 2026.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File, CMS release of October 2, 2026

Graduation Year

2022

Years since graduation

4 years (graduated 2022)

CMS Doctors and Clinicians data list 2022 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File, CMS release of October 2, 2026.

NPI first issued

2017

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians, CMS release of October 2, 2026; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians, CMS release of October 2, 2026.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Logan Wilder-Ingram has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Logan Wilder-Ingram as eligible to order or refer Medicare Part B clinical laboratory and imaging services and durable medical equipment (DME) for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Hamilton and Ohio

44 active clinicians are listed under Counselor - Professional with a practice address in Hamilton, OH (6,941 in Ohio).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Hamilton

0% of these 44 clinicians have the CMS telehealth indicator.

25% of these 44 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS release of October 2, 2026, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-10-20
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

License # reported to NPPES OH E.2505581
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OH LCDCIII.161933
Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

License # reported to NPPES OH C.2204204
Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

License # reported to NPPES OH C.2204204
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OH CDCA.167891
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OH LICDC.162260
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OH CDCA.164220
Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: State Medical Board of Ohio.
Look Up on State Board Site

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid ID
0443789 (OH)

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - MENTAL HEALTH COUNSELOR

Medicare Enrollment ID

I20251211001315

Enrollment State Jurisdiction

OH

PECOS Control ID

2365936812

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Not Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File, CMS release of October 2, 2026

Modern Psychiatry And Wellness Llc

1910 Fairgrove Ave, Hamilton, OH 450111930

Phone: 5137957557

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

1 listed
Mary Leyendecker , NP

Nurse Practitioner - Psychiatric/Mental Health

NPI 1417322397

Nurse Practitioner

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

22 Historical Events
πŸ“
Updated Practice Location October 20, 2025

Registered at 1910 FAIRGROVE AVE, HAMILTON, OH 450111930 (Tel: 5134944679)

πŸ“
Updated Business Mailing Address October 20, 2025

Registered at 1910 FAIRGROVE AVE, HAMILTON, OH 450111930 (Tel: 5134944679)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 20, 2025

Counselor (license number reported to NPPES: OH E.2505581)

πŸ“
Updated Practice Location June 05, 2024

Registered at 1 ELIZABETH PL, DAYTON, OH 454173445 (Tel: 9378131737)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) June 05, 2024

Counselor (license number reported to NPPES: OH LCDCIII.161933)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) August 16, 2023

Counselor (license number reported to NPPES: OH CDCA.164220)

πŸ“
Updated Practice Location May 23, 2023

Registered at 160 N BREIEL BLVD, MIDDLETOWN, OH 450423806 (Tel: 5139414999)

πŸ“
Updated Business Mailing Address May 23, 2023

Registered at 6460 HARRISON AVE STE 200, CINCINNATI, OH 452477958 (Tel: 5139414999)

πŸ‘€
Provider Name / Credentials Updated May 23, 2023

Recorded as LOGAN WILDER-INGRAM

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) May 23, 2023

Counselor (license number reported to NPPES: OH LICDC.162260)

πŸ“
Updated Practice Location August 10, 2021

Registered at 6460 HARRISON AVE, CINCINNATI, OH 452477957 (Tel: 5139414999)

πŸ“
Updated Business Mailing Address August 10, 2021

Registered at 3605 FIESTA WAY, MIDDLETOWN, OH 450446109 (Tel: 5135027014)

πŸ‘€
Provider Name / Credentials Updated August 10, 2021

Recorded as LOGAN WILDER-INGRAM, LCDC III, CT, QMHS

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) August 10, 2021

Counselor (license number reported to NPPES: OH C.2103188-TRNE)

πŸ“
Updated Practice Location May 21, 2021

Registered at 820 S MARTIN LUTHER KING JR BLVD, HAMILTON, OH 450113216 (Tel: 5138878500)

πŸ‘€
Provider Name / Credentials Updated May 21, 2021

Recorded as LOGAN WILDER-INGRAM, CT, LCDCIII, QMHS

βœ…
NPI Profile Active August 16, 2017

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) August 16, 2017

Registered at 442 S 2ND ST, HAMILTON, OH 450112936 (Tel: 5138684980)

πŸ“
Business Mailing Address (Initial Record) August 16, 2017

Registered at 820 S MARTIN LUTHER KING JR BLVD, HAMILTON, OH 450113216

πŸ‘€
Provider Name / Credentials (Initial Record) August 16, 2017

Recorded as LOGAN WILDER, CDCA

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) August 16, 2017

Counselor (license number reported to NPPES: OH CDCA.164220)

🟒
Initial NPI Registration & Enumeration August 16, 2017

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1760908263
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 16, 2017
Last Update: October 20, 2025
Sole Proprietor: Yes

Mailing Address

1910 Fairgrove Ave

Hamilton, OH 450111930

Phone: 5134944679

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.