Provider Demographics
NPI:1669827150
Name:LOGSTON, CHERYL LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:LOGSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 EXECUTIVE WOODS CT
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2170
Mailing Address - Country:US
Mailing Address - Phone:618-277-7570
Mailing Address - Fax:618-277-6332
Practice Address - Street 1:5 EXECUTIVE WOODS CT
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2170
Practice Address - Country:US
Practice Address - Phone:618-277-7570
Practice Address - Fax:618-277-6332
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0107431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical