Provider Demographics
NPI:1851732879
Name:LOGEL, ABBY (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:LOGEL
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 CHERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-1504
Mailing Address - Country:US
Mailing Address - Phone:303-204-5188
Mailing Address - Fax:303-761-9491
Practice Address - Street 1:1885 CHERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-1504
Practice Address - Country:US
Practice Address - Phone:303-204-5188
Practice Address - Fax:303-761-9491
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12156652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SLP0001265OtherSTATE LICENURE SPEECH PATHOLOGY DORA
CO12156652OtherASHA CERTIFICATION