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General NPI Number Information
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NPI Number | 1124370226
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Entity Type | Individual
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Provider Name | JENNIFER D LOGAN PH.D, LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 103 APPALOOSA CIR
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City | GOODFIELD
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State | IL
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Zip | 61742-9300
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Country | US
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Telephone | 309-360-2268
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Fax |
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Provider Business Mailing Address
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Address Line | 103 APPALOOSA CIR
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City | GOODFIELD
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State | IL
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Zip | 61742-9300
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Country | US
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Telephone | 309-360-2268
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178006924
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License Number State | IL
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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 | 180012370
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License Number State | IL
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