Provider Demographics
NPI:1689169526
Name:BOZEMAN, CECELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:BOZEMAN
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 1:1531 WATKINS LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9264
Mailing Address - Country:US
Mailing Address - Phone:312-685-0718
Mailing Address - Fax:
Practice Address - Street 1:440 W BOUGHTON RD STE 104
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1400
Practice Address - Country:US
Practice Address - Phone:331-318-8181
Practice Address - Fax:630-863-7293
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0189981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical