Provider Demographics
NPI:1427160647
Name:BOGDANOFF, PAULINE KRANDEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:KRANDEL
Last Name:BOGDANOFF
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 1:110 E SCHILLER ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2823
Mailing Address - Country:US
Mailing Address - Phone:630-834-6858
Mailing Address - Fax:
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2823
Practice Address - Country:US
Practice Address - Phone:630-834-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02273035OtherBLUE CROSS BLUE SHIELD
IL02273035OtherBLUE CROSS BLUE SHIELD