Individual
DENNIS BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Mailing address
5207 S DREXEL AVE APT S2A, CHICAGO, IL 60615-3719
(202) 486-3203
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.011443
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/19/2019
Last updated
04/19/2019
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