Individual
RICHARD HENRY LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1010 LAKE ST STE 110, OAK PARK, IL 60301-1106
(331) 529-7413
(877) 428-7891
Mailing address
8649 NEW ENGLAND AVE, BURBANK, IL 60459-2216
(708) 548-8308
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.028575
IL
Other
Enumeration date
11/21/2023
Last updated
05/15/2024
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