Healthcare Provider Details

I. General information

NPI: 1912019472
Provider Name (Legal Business Name): BONNIE HOLT LOGSDON R.D., IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE ELIZABETH HOLT R.D., L.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 BROWNSBORO PARK BLVD STE D
LOUISVILLE KY
40207-1292
US

IV. Provider business mailing address

1341 S 2ND ST
LOUISVILLE KY
40208-2303
US

V. Phone/Fax

Practice location:
  • Phone: 270-202-9545
  • Fax:
Mailing address:
  • Phone: 270-202-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number276810
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: