Provider Demographics
NPI:1598399099
Name:BONILLA, EMMA REAL (LCPC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:REAL
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E OGDEN AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3590
Mailing Address - Country:US
Mailing Address - Phone:312-620-0546
Mailing Address - Fax:
Practice Address - Street 1:119 E OGDEN AVE STE 200B
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3590
Practice Address - Country:US
Practice Address - Phone:312-620-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014199101YP2500X
IL178.015519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional