Provider Demographics
NPI:1932220191
Name:BODEN, CHRIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:BODEN
Suffix:
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 1:2854 CEDAR GLADE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8443
Mailing Address - Country:US
Mailing Address - Phone:630-697-4948
Mailing Address - Fax:
Practice Address - Street 1:13300 S ROUTE 59 STE B7
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5201
Practice Address - Country:US
Practice Address - Phone:815-577-3666
Practice Address - Fax:815-577-2785
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical