Provider Demographics
NPI:1275865891
Name:CADDLE-LOGAN, ANN-MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANN-MARIE
Middle Name:
Last Name:CADDLE-LOGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 SW BIANCA AVE,
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2861
Mailing Address - Country:US
Mailing Address - Phone:772-206-0318
Mailing Address - Fax:
Practice Address - Street 1:974 SW BIANCA AVE,
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2861
Practice Address - Country:US
Practice Address - Phone:772-206-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health