Provider Demographics
NPI:1841706504
Name:BOHNENKAMP, ALEXANDER LEE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEE
Last Name:BOHNENKAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5874 CHRISTA DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9047
Mailing Address - Country:US
Mailing Address - Phone:319-457-2317
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1243
Practice Address - Country:US
Practice Address - Phone:319-523-8436
Practice Address - Fax:319-523-8436
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)