Healthcare Provider Details

I. General information

NPI: 1063104883
Provider Name (Legal Business Name): COURTNEY LOGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W DUNDEE RD
BUFFALO GROVE IL
60089-3545
US

IV. Provider business mailing address

1550 AUTUMN DR APT 308
HOFFMAN ESTATES IL
60169-1675
US

V. Phone/Fax

Practice location:
  • Phone: 847-777-8995
  • Fax:
Mailing address:
  • Phone: 309-502-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030351
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: