Provider Demographics
NPI:1477947554
Name:COON, BONNIE L (MA, LSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:COON
Suffix:
Gender:F
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1015
Mailing Address - Country:US
Mailing Address - Phone:765-282-7150
Mailing Address - Fax:765-282-9166
Practice Address - Street 1:4221 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1015
Practice Address - Country:US
Practice Address - Phone:765-282-7150
Practice Address - Fax:765-282-9166
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33003343A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker