Provider Demographics
NPI:1609268903
Name:KOGAN, TONI ANNE (MA, LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:ANNE
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W MONROE ST
Mailing Address - Street 2:1027
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-4901
Mailing Address - Country:US
Mailing Address - Phone:312-420-7637
Mailing Address - Fax:
Practice Address - Street 1:79 W MONROE ST
Practice Address - Street 2:1027
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4901
Practice Address - Country:US
Practice Address - Phone:312-420-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30482101YA0400X
IL180.009485101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health