Healthcare Provider Details

I. General information

NPI: 1548706005
Provider Name (Legal Business Name): JENNIFER LOGSTON COUNSELING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 ROGERS ST FL 2
DOWNERS GROVE IL
60515-3774
US

IV. Provider business mailing address

900 OGDEN AVE # 112
DOWNERS GROVE IL
60515-2829
US

V. Phone/Fax

Practice location:
  • Phone: 630-528-8855
  • Fax: 331-291-5116
Mailing address:
  • Phone: 630-528-8855
  • Fax: 331-291-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KEELY LOGSTON
Title or Position: PRESIDENT
Credential: LCSW
Phone: 630-528-8885