Provider Demographics
NPI:1194277780
Name:BOYKIN-MILES, JANICE NADEAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:NADEAN
Last Name:BOYKIN-MILES
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 1:2629 E 142ND ST
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-2003
Mailing Address - Country:US
Mailing Address - Phone:708-699-7086
Mailing Address - Fax:708-575-3115
Practice Address - Street 1:2629 E 142ND ST
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2003
Practice Address - Country:US
Practice Address - Phone:708-699-6086
Practice Address - Fax:708-575-3115
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0187011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical