Provider Demographics
NPI:1548394281
Name:KOSS, BONNIE JOYCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JOYCE
Last Name:KOSS
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 1:1405 BOB O LINK RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3003
Mailing Address - Country:US
Mailing Address - Phone:847-831-5423
Mailing Address - Fax:
Practice Address - Street 1:115 S WILKE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1532
Practice Address - Country:US
Practice Address - Phone:847-259-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635406OtherBLUE CROSS BLUE SHEILD
IL212288Medicare ID - Type Unspecified