Provider Demographics
NPI:1306611405
Name:BOONE, CLIFTON R JR (LSW, CADC)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:R
Last Name:BOONE
Suffix:JR
Gender:M
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S RIVER RD STE 246
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4111
Mailing Address - Country:US
Mailing Address - Phone:847-306-7277
Mailing Address - Fax:847-306-7278
Practice Address - Street 1:3053 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1000
Practice Address - Country:US
Practice Address - Phone:773-475-6703
Practice Address - Fax:773-475-6745
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4168617101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health