Basic Information
| Provider Information | |||||||||
| NPI: | 1811191539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROIKO BOGUST | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROIKO | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 912 S WOOD ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129967206 | ||||||||
| FaxNumber: | 3129969788 | ||||||||
| Practice Location | |||||||||
| Address1: | 912 S WOOD ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129967206 | ||||||||
| FaxNumber: | 3129969788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.