Provider Demographics
NPI:1407091937
Name:BROTHERTON, BONNIE M (LISW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1448
Mailing Address - Country:US
Mailing Address - Phone:614-889-5226
Mailing Address - Fax:614-793-1876
Practice Address - Street 1:2900 MARTIN RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1448
Practice Address - Country:US
Practice Address - Phone:614-889-5226
Practice Address - Fax:614-793-1876
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist