Individual
MRS. TERRI KATHRYN LOGSDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
197 SW TWIG AVE, PORT SAINT LUCIE, FL 34983-3031
(772) 340-1130
Mailing address
197 SW TWIG AVE, PORT SAINT LUCIE, FL 34983-3031
(772) 340-1130
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2306255 00
—
FL
Enumeration date
05/19/2008
Last updated
05/19/2008
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