Provider Demographics
NPI:1447783774
Name:BONILLA, LESLIE MARILYN (LSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARILYN
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5053
Mailing Address - Country:US
Mailing Address - Phone:775-378-2775
Mailing Address - Fax:775-525-3889
Practice Address - Street 1:438 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5053
Practice Address - Country:US
Practice Address - Phone:775-378-2775
Practice Address - Fax:775-525-3889
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8834-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical