Provider Demographics
NPI:1245426758
Name:BOLDT, SHOJI MARY (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:SHOJI
Middle Name:MARY
Last Name:BOLDT
Suffix:
Gender:F
Credentials:MA, LCPC
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Mailing Address - Street 1:111 LIONS DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3182
Mailing Address - Country:US
Mailing Address - Phone:847-347-0688
Mailing Address - Fax:847-381-1599
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:SUITE 221
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-347-0688
Practice Address - Fax:847-381-1599
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2010-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL180.004697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1437470234OtherNPI TYPE 2