Individual provider Active NPI

Gail Logemann, LMFT

  • Marriage & Family Therapist
  • Rockford, IL
National Provider Identifier
1083802540
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
461 N Mulford Rd
Condo #1
Rockford, IL 61107-5190
Phone
(815) 395-1141
Fax
(815) 395-1117
NPI assigned
Oct 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IL Primary

Addresses

Primary practice location

461 N Mulford Rd
Condo #1
Rockford, IL 61107-5190

Mailing address

461 N Mulford Rd
Condo #1
Rockford, IL 61107-5190
Phone (815) 395-1141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240625002014 IL Practitioner - Marriage and Family Therapist 2860935327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Behavioral Care Therapy Services of Illinois PCGroup PAC ID 2163944190, 20 clinicians

Practice addresses (Care Compare)

6392 Linden Rd
Rockford, IL 61109-2816
Phone (779) 368-0060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
166000602ILMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
KP Counseling LTD CurrentSince May 12, 2024 Accepting new patients
Optum Behavioral Care Therapy Services of Illinois PC CurrentSince Mar 15, 2025 Accepting new patients
Optum Behavioral Care Therapy Services of Illinois PC CurrentSince Mar 15, 2025 Accepting new patients

Locations

4753 N Broadway St
Ste 403
Chicago, IL 60640
Phone (773) 989-2780

12151 Regency Pkwy
Ste 12189
Huntley, IL 60142
Phone (779) 368-0660

461 N Mulford Rd
Ste 1
Rockford, IL 61107
Phone (815) 395-1141

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1083802540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 N MULFORD RD",
            "address_2": "CONDO #1",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075190",
            "telephone_number": "815-395-1141",
            "fax_number": "815-395-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 N MULFORD RD",
            "address_2": "CONDO #1",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075190",
            "telephone_number": "815-395-1141",
            "fax_number": "815-395-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGEMANN",
        "first_name": "GAIL",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.