Individual
DR. DIANNA W BOLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4350 N HERMITAGE AVE, CHICAGO, IL 60613-1106
(773) 327-9356
(773) 348-8220
Mailing address
4350 N HERMITAGE AVE, CHICAGO, IL 60613-1106
(773) 327-9356
(773) 348-8220
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632869
BCBS
IL
Enumeration date
03/09/2007
Last updated
06/29/2009
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