Provider Demographics
NPI:1376521088
Name:BOCHENEK, ELAINE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:BOCHENEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021
Mailing Address - Country:US
Mailing Address - Phone:815-285-8394
Mailing Address - Fax:
Practice Address - Street 1:115 W FIRST ST
Practice Address - Street 2:STE 250
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3064
Practice Address - Country:US
Practice Address - Phone:815-285-8394
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204441Medicare ID - Type Unspecified