Individual
KYLIE G LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CD, CLEC
Contact information
Practice address
101 SCHOFIELD RD, WILLINGTON, CT 06279-2246
(860) 416-4859
Mailing address
101 SCHOFIELD RD, WILLINGTON, CT 06279-2246
(860) 416-4859
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Enumeration date
07/13/2011
Last updated
04/02/2020
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