Provider Demographics
NPI:1093764227
Name:TAYLOR, BONNIE JO (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JO
Other - Last Name:BUMPUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC
Mailing Address - Street 1:351 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:43734-9707
Mailing Address - Country:US
Mailing Address - Phone:740-674-7269
Mailing Address - Fax:
Practice Address - Street 1:2845 BELL ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1720
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI103021041C0700X
OH976064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTASW29511Medicare PIN