Provider Demographics
NPI:1841692100
Name:LOGSDON, ADRIANNE CLAIRE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ADRIANNE
Middle Name:CLAIRE
Last Name:LOGSDON
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 1:2748 OWENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-7707
Mailing Address - Country:US
Mailing Address - Phone:270-287-8572
Mailing Address - Fax:
Practice Address - Street 1:2748 OWENSBORO RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-7707
Practice Address - Country:US
Practice Address - Phone:270-287-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12088909235Z00000X
KYKY-3257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGNOO8Medicaid