Individual
JAKE THOMAS LOGSDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TCADC
Contact information
Practice address
830 W BROADWAY ST, CAMPBELLSVILLE, KY 42718-2701
(866) 934-7450
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
275818
KY
Other
Enumeration date
02/22/2023
Last updated
02/22/2023
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