Individual
NELL LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
636 CHURCH ST, #409, EVANSTON, IL 60201
(847) 328-8886
Mailing address
636 CHURCH ST, #409, EVANSTON, IL 60201
(847) 328-8886
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071001854
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001672439
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/22/2005
Last updated
07/05/2012
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