Provider Demographics
NPI:1285820670
Name:BODINE, MENDY MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MENDY
Middle Name:MICHELLE
Last Name:BODINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 95TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8944
Mailing Address - Country:US
Mailing Address - Phone:306-753-9800
Mailing Address - Fax:
Practice Address - Street 1:2272 95TH STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8944
Practice Address - Country:US
Practice Address - Phone:630-753-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490112621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical