Provider Demographics
NPI:1922192814
Name:BOCKSTAHLER, DYANN K (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DYANN
Middle Name:K
Last Name:BOCKSTAHLER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 W 216TH STREET
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2713
Mailing Address - Country:US
Mailing Address - Phone:708-481-4080
Mailing Address - Fax:708-481-7725
Practice Address - Street 1:3624 W 216TH STREET
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2713
Practice Address - Country:US
Practice Address - Phone:708-481-4080
Practice Address - Fax:708-481-7725
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
01636410OtherBCBS
597340Medicare ID - Type Unspecified