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General NPI Number Information
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NPI Number | 1003996307
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Entity Type | Individual
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Provider Name | LANA YAEL LOGAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 10730 W 143RD ST STE 32
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City | ORLAND PARK
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State | IL
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Zip | 60462-1976
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Country | US
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Telephone | 312-502-0118
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Fax | 708-675-7574
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Provider Business Mailing Address
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Address Line | 5844 ELAINE DR STE 103
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City | ROCKFORD
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State | IL
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Zip | 61108-2494
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Country | US
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Telephone | 312-502-0118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180007562
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License Number State | IL
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