Basic Information
| Provider Information | |||||||||
| NPI: | 1205093838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOGUE | ||||||||
| FirstName: | KACIE | ||||||||
| MiddleName: | HUMISTON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 SE CARY PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194609955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 SE CARY PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194609955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8000 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.