Provider Demographics
NPI:1922291954
Name:LOGGIN, GLADYS (RT)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:LOGGIN
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 BALLANTRAE WAY
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4378
Mailing Address - Country:US
Mailing Address - Phone:708-473-6883
Mailing Address - Fax:708-991-7171
Practice Address - Street 1:3914 BALLANTRAE WAY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4378
Practice Address - Country:US
Practice Address - Phone:708-473-6883
Practice Address - Fax:708-991-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified