Provider Demographics
NPI:1851089387
Name:BONNER, ALEXANDRA MARILYN (CSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARILYN
Last Name:BONNER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 N REDWOOD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6759
Mailing Address - Country:US
Mailing Address - Phone:385-202-5645
Mailing Address - Fax:
Practice Address - Street 1:2179 N REDWOOD RD UNIT 2
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6759
Practice Address - Country:US
Practice Address - Phone:385-202-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14060513-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical