Provider Demographics
NPI:1447326608
Name:BOZEDAY, JOHN (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOZEDAY
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 1:235 RIDGE RD
Mailing Address - Street 2:UNIT 4C
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3299
Mailing Address - Country:US
Mailing Address - Phone:847-251-0346
Mailing Address - Fax:
Practice Address - Street 1:708 CHURCH ST
Practice Address - Street 2:SUITE 258
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3875
Practice Address - Country:US
Practice Address - Phone:847-251-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0030051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149003005OtherSTATE LICENSE