Provider Demographics
NPI:1740622315
Name:BOGIE, PATRCIA L (LCSW, CADC, MISA II)
Entity type:Individual
Prefix:
First Name:PATRCIA
Middle Name:L
Last Name:BOGIE
Suffix:
Gender:F
Credentials:LCSW, CADC, MISA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 WEST LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661
Mailing Address - Country:US
Mailing Address - Phone:312-655-7459
Mailing Address - Fax:312-948-6001
Practice Address - Street 1:651 WEST LAKE STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661
Practice Address - Country:US
Practice Address - Phone:312-655-7459
Practice Address - Fax:312-948-6001
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12910101YA0400X
IL14900089971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)