Healthcare Provider Details

I. General information

NPI: 1154094688
Provider Name (Legal Business Name): MISS LOGAN ELIZABETH STRANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 UNIVERSITY EXEC PARK DR STE 825
CHARLOTTE NC
28262-1346
US

IV. Provider business mailing address

5725 CARNEGIE BLVD APT 119
CHARLOTTE NC
28209-4870
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-1616
  • Fax:
Mailing address:
  • Phone: 724-996-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number30000849
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: