Healthcare Provider Details

I. General information

NPI: 1558761700
Provider Name (Legal Business Name): TERRI BUKOFZER LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AMERICAN WAY
ELGIN IL
60120-4341
US

IV. Provider business mailing address

278 HOBBLE BUSH LN
VERNON HILLS IL
60061-3145
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3545
  • Fax: 847-742-3559
Mailing address:
  • Phone: 847-742-3545
  • Fax: 847-697-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number149.016786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: