Provider Demographics
NPI:1942775077
Name:LOGUE, KRISTA (AAC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:LOGUE
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16225 NE 87TH ST STE B-3
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3536
Mailing Address - Country:US
Mailing Address - Phone:425-968-5921
Mailing Address - Fax:
Practice Address - Street 1:16225 NE 87TH ST STE B-3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3536
Practice Address - Country:US
Practice Address - Phone:425-968-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator