Provider Demographics
NPI:1548706005
Name:JENNIFER LOGSTON COUNSELING LTD
Entity type:Organization
Organization Name:JENNIFER LOGSTON COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KEELY
Authorized Official - Last Name:LOGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-528-8885
Mailing Address - Street 1:900 OGDEN AVE # 112
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2829
Mailing Address - Country:US
Mailing Address - Phone:630-528-8855
Mailing Address - Fax:
Practice Address - Street 1:5010 FAIRVIEW AVE STE 5
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5201
Practice Address - Country:US
Practice Address - Phone:630-528-8855
Practice Address - Fax:630-541-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 104100000X, 1041C0700X
IL149-0086321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty