Provider Demographics
NPI:1326637067
Name:LOGSDON, CHRISTINE NICOLE (BSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12687 US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:KY
Mailing Address - Zip Code:42376-9173
Mailing Address - Country:US
Mailing Address - Phone:270-929-8089
Mailing Address - Fax:
Practice Address - Street 1:434 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1121
Practice Address - Country:US
Practice Address - Phone:270-504-0068
Practice Address - Fax:270-298-8717
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator