Provider Demographics
NPI:1003996307
Name:LOGAN, LANA YAEL (LCPC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:YAEL
Last Name:LOGAN
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 ELAINE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2494
Mailing Address - Country:US
Mailing Address - Phone:312-502-0118
Mailing Address - Fax:
Practice Address - Street 1:10730 W 143RD ST STE 32
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1976
Practice Address - Country:US
Practice Address - Phone:312-502-0118
Practice Address - Fax:708-675-7574
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL180007562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker