Provider Demographics
NPI:1689198251
Name:STOHLE, LOGAN
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:
Last Name:STOHLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 W SHAKESPEARE AVE UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6464
Mailing Address - Country:US
Mailing Address - Phone:847-636-9528
Mailing Address - Fax:
Practice Address - Street 1:2352 W SHAKESPEARE AVE UNIT 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6464
Practice Address - Country:US
Practice Address - Phone:847-636-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical