Provider Demographics
NPI:1083705271
Name:DANIELS, BONNIE LEE (MSW LISW-S)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MSW LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 MT. ZION RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9512
Mailing Address - Country:US
Mailing Address - Phone:740-654-8718
Mailing Address - Fax:740-654-8718
Practice Address - Street 1:635 MT. ZION RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9512
Practice Address - Country:US
Practice Address - Phone:740-654-8718
Practice Address - Fax:740-654-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00097191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000327800OtherANTHEM
OH546919OtherVALUE OPTIONS
OH261217OtherCOMP PSYCH
OH0331945Medicaid
OH588637000OtherMAGELLAN