Provider Demographics
NPI:1912019472
Name:LOGSDON, BONNIE HOLT (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:HOLT
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:ELIZABETH
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:619 W SAINT CATHERINE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-4103
Mailing Address - Country:US
Mailing Address - Phone:270-202-9545
Mailing Address - Fax:
Practice Address - Street 1:619 W SAINT CATHERINE ST APT 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-4103
Practice Address - Country:US
Practice Address - Phone:270-202-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0277910Medicare PIN
KY0049049Medicare PIN
KY0277410Medicare PIN
KY0277610Medicare PIN
KY9366305Medicare PIN
KYQ13254Medicare UPIN
KY0277507Medicare PIN
KY0277809Medicare PIN
KY0277710Medicare PIN