1083705271 NPI number — BONNIE LEE DANIELS MSW LISW-S

Table of content: BONNIE LEE DANIELS MSW LISW-S (NPI 1083705271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083705271 NPI number — BONNIE LEE DANIELS MSW LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIELS
Provider First Name:
BONNIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083705271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
695 MT. ZION RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-9512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-654-8718
Provider Business Mailing Address Fax Number:
740-654-8718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 MT. ZION RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-654-8718
Provider Business Practice Location Address Fax Number:
740-654-8718
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I0009719 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000327800 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 546919 . This is a "VALUE OPTIONS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 261217 . This is a "COMP PSYCH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0331945 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 588637000 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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