Healthcare Provider Details

I. General information

NPI: 1477463123
Provider Name (Legal Business Name): LAUREN LOGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 W FLETCHER AVE
TAMPA FL
33612-3310
US

IV. Provider business mailing address

4517 W ROSEMERE RD
TAMPA FL
33609-4209
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-4879
  • Fax:
Mailing address:
  • Phone: 813-269-4879
  • Fax: 813-433-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: