Provider Demographics
NPI:1063898732
Name:CARTER, LOGAN D (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:D
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 STATESVILLE RD STE 4150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-332-4834
Mailing Address - Fax:704-372-9653
Practice Address - Street 1:1441 ASHCRAFT LANE
Practice Address - Street 2:APT B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:910-527-3086
Practice Address - Fax:704-372-9653
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
NC12008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist