Healthcare Provider Details

I. General information

NPI: 1972731040
Provider Name (Legal Business Name): KATHERINE CHIFFON LOGAN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S SWOOPE AVE STE 210
MAITLAND FL
32751-5784
US

IV. Provider business mailing address

PO BOX 120547
CLERMONT FL
34712-0547
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4122
  • Fax:
Mailing address:
  • Phone: 352-394-0212
  • Fax: 352-241-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: