Healthcare Provider Details

I. General information

NPI: 1356278352
Provider Name (Legal Business Name): MADISON LOGER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 IL-2 DIXON, IL 61021
DIXON IL
61021
US

IV. Provider business mailing address

407 DIXON AVE
ROCK FALLS IL
61071-1751
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax: 815-246-3370
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150116032
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: