MEDICARE: LOGAN KATHLEEN ALLEY SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	11567	MD

General Provider Information

NPI Number	:	1366336026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN KATHLEEN ALLEY SLP

Provider Business Mailing Address
First Line	:	4819 WALDEN LN STE 4880
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4826
Country	:	US
Telephone Number	:	240-667-1423
Fax Number	:	240-667-1423

Provider Business Practice Location Address
First Line	:	4819 WALDEN LN STE 4880
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4826
Country	:	US
Telephone Number	:	240-667-1423
Fax Number	:	240-667-1423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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Directions to “ LOGAN KATHLEEN ALLEY SLP” Practice Location

Language	Start Address	Practice Location

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