Provider Demographics
NPI:1629039151
Name:LOGSDON, CELIA W (AUD)
Entity Type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:W
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2237
Mailing Address - Country:US
Mailing Address - Phone:978-283-6888
Mailing Address - Fax:978-283-8655
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2237
Practice Address - Country:US
Practice Address - Phone:978-283-6888
Practice Address - Fax:978-283-8655
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-02
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110062782AMedicaid
MA110062782AMedicaid