Provider Demographics
NPI:1679914550
Name:KILFOYLE, BONNIE (ED S)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KILFOYLE
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 W VICTORIA ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4223
Mailing Address - Country:US
Mailing Address - Phone:347-668-8537
Mailing Address - Fax:
Practice Address - Street 1:954 W WASHINGTON BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2224
Practice Address - Country:US
Practice Address - Phone:312-432-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2575907103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool