Provider Demographics
NPI:1154852309
Name:BONNETT, KAILLY ALLYCE (MS LADC LPCC)
Entity Type:Individual
Prefix:
First Name:KAILLY
Middle Name:ALLYCE
Last Name:BONNETT
Suffix:
Gender:F
Credentials:MS LADC LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 17TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-2754
Mailing Address - Country:US
Mailing Address - Phone:218-349-9975
Mailing Address - Fax:
Practice Address - Street 1:911 18TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1203
Practice Address - Country:US
Practice Address - Phone:320-650-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01951101YM0800X
MN304645101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)