Provider Demographics
NPI:1316467061
Name:BONEBRAKE, AMY R (LMSW, CADC, SAP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:BONEBRAKE
Suffix:
Gender:F
Credentials:LMSW, CADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 GREENBELT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-9619
Mailing Address - Country:US
Mailing Address - Phone:319-243-9020
Mailing Address - Fax:
Practice Address - Street 1:3640 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5705
Practice Address - Country:US
Practice Address - Phone:319-252-4631
Practice Address - Fax:319-252-4631
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09007101YA0400X
IA109128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty