Provider Demographics
NPI:1205093838
Name:LOGUE, KACIE HUMISTON (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:HUMISTON
Last Name:LOGUE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SE CARY PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5682
Mailing Address - Country:US
Mailing Address - Phone:919-460-9955
Mailing Address - Fax:
Practice Address - Street 1:750 SE CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5682
Practice Address - Country:US
Practice Address - Phone:919-460-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC522085557Medicare PIN