Provider Demographics
NPI:1811191539
Name:ROIKO BOGUST, ANGELA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:ROIKO BOGUST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:ROIKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:912 S WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-996-7206
Mailing Address - Fax:312-996-9788
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-7206
Practice Address - Fax:312-996-9788
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2008-03-19
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
ILK39028Medicare PIN