Provider Demographics
NPI:1467528521
Name:SJOSTROM, BRADLEY PHILIP (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:PHILIP
Last Name:SJOSTROM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 W NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6704
Mailing Address - Country:US
Mailing Address - Phone:773-296-5159
Mailing Address - Fax:773-296-3226
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:773-296-5159
Practice Address - Fax:773-296-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0085701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical