Provider Demographics
NPI:1487463568
Name:LOGSDON, SUSANNE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 WHITEFENCE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1871
Mailing Address - Country:US
Mailing Address - Phone:773-332-1899
Mailing Address - Fax:
Practice Address - Street 1:9 CRYSTAL LAKE RD STE 150
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1254
Practice Address - Country:US
Practice Address - Phone:847-802-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health