MEDICARE: DR. LOGAN STOHLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1194599902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LOGAN STOHLE, LLC

Provider Business Mailing Address
First Line	:	2352 W SHAKESPEARE AVE UNIT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6464
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE STE 210A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3122
Country	:	US
Telephone Number	:	847-636-9528
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. LOGAN STOHLE
Credential	:	PSYD
Telephone Number	:	847-636-9528

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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