Provider Demographics
NPI:1013394543
Name:BONIN, AMY (MS - TLMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BONIN
Suffix:
Gender:F
Credentials:MS - TLMHC
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 1453
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1453
Mailing Address - Country:US
Mailing Address - Phone:641-752-5421
Mailing Address - Fax:641-752-7211
Practice Address - Street 1:9 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1836
Practice Address - Country:US
Practice Address - Phone:641-752-5421
Practice Address - Fax:641-752-7211
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health