Provider Demographics
NPI:1104582329
Name:LOGWOOD, STACIA ANNE
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:ANNE
Last Name:LOGWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2969 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:WV
Mailing Address - Zip Code:25081-6185
Mailing Address - Country:US
Mailing Address - Phone:571-719-1157
Mailing Address - Fax:
Practice Address - Street 1:2969 FOSTER RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:WV
Practice Address - Zip Code:25081-6185
Practice Address - Country:US
Practice Address - Phone:571-719-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant