Provider Demographics
NPI:1861463853
Name:BONNER, NANCY H (LSCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:H
Last Name:BONNER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W 27TH TER
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4618
Mailing Address - Country:US
Mailing Address - Phone:785-312-7273
Mailing Address - Fax:785-865-1399
Practice Address - Street 1:2323 RIDGE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3956
Practice Address - Country:US
Practice Address - Phone:785-865-5300
Practice Address - Fax:785-865-1399
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097940AMedicaid
KS069494Medicare ID - Type Unspecified