Provider Demographics
NPI:1255147757
Name:BOLKER, JEFFREY S I (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:BOLKER
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N DRURY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4050
Mailing Address - Country:US
Mailing Address - Phone:312-354-0950
Mailing Address - Fax:
Practice Address - Street 1:1720 N DRURY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4050
Practice Address - Country:US
Practice Address - Phone:312-354-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490033541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical