Provider Demographics
NPI:1114119781
Name:BONNES AND VASQUEZ, P.C.
Entity Type:Organization
Organization Name:BONNES AND VASQUEZ, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BONNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/ACSW
Authorized Official - Phone:708-952-4662
Mailing Address - Street 1:13152 S. CICERO AVE
Mailing Address - Street 2:PMB 260
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60459
Mailing Address - Country:US
Mailing Address - Phone:708-565-5629
Mailing Address - Fax:708-636-3772
Practice Address - Street 1:13152 S. CICERO AVE
Practice Address - Street 2:PMB 260
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60459
Practice Address - Country:US
Practice Address - Phone:708-565-5629
Practice Address - Fax:708-636-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty