Provider Demographics
NPI:1528392065
Name:HARRIS, BONNIE JEAN BAKER (LBSW, LLMSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN BAKER
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LBSW, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:901 EASTERN AVE. NE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-0294
Mailing Address - Country:US
Mailing Address - Phone:616-224-7476
Mailing Address - Fax:616-224-7589
Practice Address - Street 1:901 EASTERN AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1201
Practice Address - Country:US
Practice Address - Phone:616-224-7476
Practice Address - Fax:616-224-7589
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091590104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker