Provider Demographics
NPI:1801944046
Name:BUSHMA, DAWN M (LCSW, CADC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:BUSHMA
Suffix:
Gender:F
Credentials:LCSW, CADC
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 717
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-0717
Mailing Address - Country:US
Mailing Address - Phone:708-476-7726
Mailing Address - Fax:630-629-9424
Practice Address - Street 1:7314 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-3161
Practice Address - Country:US
Practice Address - Phone:708-476-7726
Practice Address - Fax:630-629-9424
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3797101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical