Provider Demographics
NPI:1154672012
Name:BOVA, JODI ANN (LCPC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:BOVA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 S UNION AVE
Mailing Address - Street 2:#2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3426
Mailing Address - Country:US
Mailing Address - Phone:312-401-9589
Mailing Address - Fax:
Practice Address - Street 1:3437 S UNION AVE
Practice Address - Street 2:#2F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3426
Practice Address - Country:US
Practice Address - Phone:312-401-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional