Provider Demographics
NPI:1588825103
Name:BOLNICK, LORI ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:BOLNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 WALDEN OFFICE SQ STE 400
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4273
Mailing Address - Country:US
Mailing Address - Phone:224-220-0277
Mailing Address - Fax:224-592-8080
Practice Address - Street 1:1821 WALDEN OFFICE SQ STE 400
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:224-220-0277
Practice Address - Fax:224-592-8080
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TH0004X, 103TM1800X
IL071-007057103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities