Provider Demographics
NPI:1013381060
Name:BONAR, ASHLEE (EDS)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:BONAR
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:ORANGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44453-0174
Mailing Address - Country:US
Mailing Address - Phone:330-647-5305
Mailing Address - Fax:
Practice Address - Street 1:6000 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4624
Practice Address - Country:US
Practice Address - Phone:330-505-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3143171103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool