Provider Demographics
NPI:1366729584
Name:BONNEVIER, NANCY L (LCPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:BONNEVIER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6359
Mailing Address - Country:US
Mailing Address - Phone:708-770-3270
Mailing Address - Fax:
Practice Address - Street 1:9153 FAIRMONT CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6524
Practice Address - Country:US
Practice Address - Phone:708-770-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional