Provider Demographics
NPI:1942017843
Name:BOSTLER, BAILEY
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:BOSTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 N CLARK ST # B-1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-0751
Mailing Address - Country:US
Mailing Address - Phone:773-755-4738
Mailing Address - Fax:
Practice Address - Street 1:5537 N CLARK ST # B-1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-0751
Practice Address - Country:US
Practice Address - Phone:773-755-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional