Provider Demographics
NPI:1043418296
Name:BOWLES, COURTNEY BLUM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BLUM
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1719
Mailing Address - Country:US
Mailing Address - Phone:310-403-3825
Mailing Address - Fax:
Practice Address - Street 1:1585 ELLINWOOD AVE
Practice Address - Street 2:STE 106
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4510
Practice Address - Country:US
Practice Address - Phone:310-403-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0119491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical