Provider Demographics
NPI:1194862490
Name:LOGUE, HEATHER RAE (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:LOGUE
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COLBERN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2317
Mailing Address - Country:US
Mailing Address - Phone:816-348-1575
Mailing Address - Fax:
Practice Address - Street 1:315 COLBERN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2317
Practice Address - Country:US
Practice Address - Phone:816-348-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0344759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist