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NPI Code Detail

MEDICARE: JENNIFER LOGSTON COUNSELING LTD

MEDICARE: JENNIFER LOGSTON COUNSELING LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101Y00000XCounselor
3104100000XSocial Worker
4101YP2500XProfessional Counselor
51041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548706005
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER LOGSTON COUNSELING LTD
Provider Business Mailing Address
First Line : 900 OGDEN AVE # 112
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-2829
Country : US
Telephone Number : 630-528-8855
Fax Number : 331-291-5116
Provider Business Practice Location Address
First Line : 603 ROGERS ST FL 2
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-3774
Country : US
Telephone Number : 630-528-8855
Fax Number : 331-291-5116
Authorized Official
Title or Position : PRESIDENT
Name : JENNIFER KEELY LOGSTON
Credential : LCSW
Telephone Number : 630-528-8885
Provider Enumeration Date : 01/09/2017
Last Update Date : 03/02/2026

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