Healthcare Provider Details

I. General information

NPI: 1285000752
Provider Name (Legal Business Name): CHRISTEN LOGUE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HOUSTON RD
FLORENCE KY
41042-4824
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5901
  • Fax: 859-301-5940
Mailing address:
  • Phone: 859-301-5901
  • Fax: 859-301-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129162
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number129162
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: