Provider Demographics
NPI:1467640086
Name:BOSWELL, ANGELA M (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:181 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HUME
Mailing Address - State:IL
Mailing Address - Zip Code:61932-7201
Mailing Address - Country:US
Mailing Address - Phone:217-433-3453
Mailing Address - Fax:
Practice Address - Street 1:181 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HUME
Practice Address - State:IL
Practice Address - Zip Code:61932-7201
Practice Address - Country:US
Practice Address - Phone:217-433-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X
IL149.0261191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)