Provider Demographics
NPI:1568607638
Name:BAIR, BONNIE LOU (MS LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOU
Last Name:BAIR
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 KNOX COUNTY ROAD 700 EAST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-8814
Mailing Address - Country:US
Mailing Address - Phone:309-335-6782
Mailing Address - Fax:309-341-2030
Practice Address - Street 1:1798 KNOX COUNTY ROAD 700 EAST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-8814
Practice Address - Country:US
Practice Address - Phone:309-335-6782
Practice Address - Fax:309-341-2030
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001953101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor