Provider Demographics
NPI:1518488683
Name:RIPHAGEN, BONNIE (LMSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:RIPHAGEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5344
Mailing Address - Country:US
Mailing Address - Phone:515-576-7261
Mailing Address - Fax:515-576-7268
Practice Address - Street 1:726 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5344
Practice Address - Country:US
Practice Address - Phone:515-576-7261
Practice Address - Fax:515-576-7268
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health