MEDICARE: LOI L LOGAN LSW

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
1	1041C0700X	Clinical Social Worker	149017364	IL
2	104100000X	Social Worker	149017364	IL

General Provider Information

NPI Number	:	1699015412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOI L LOGAN LSW

Provider Business Mailing Address
First Line	:	609 BRIDGEPORT PL
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-2624
Country	:	US
Telephone Number	:	224-399-6646
Fax Number	:	630-787-0484

Provider Business Practice Location Address
First Line	:	609 BRIDGEPORT PL
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-2624
Country	:	US
Telephone Number	:	224-399-6646
Fax Number	:	630-787-0484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	06/19/2026

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Directions to “ LOI L LOGAN LSW” Practice Location

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