Provider Demographics
NPI:1275903213
Name:SHULTZ, BONNIE (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:LETINICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6068 OSPREY CIR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-8807
Mailing Address - Country:US
Mailing Address - Phone:360-813-1374
Mailing Address - Fax:
Practice Address - Street 1:6068 OSPREY CIR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-8807
Practice Address - Country:US
Practice Address - Phone:360-813-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000053661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical