Provider Demographics
NPI:1578271938
Name:AKALIS, BONNI GEMMELL (MA,LMSW)
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:GEMMELL
Last Name:AKALIS
Suffix:
Gender:F
Credentials:MA,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 DUXBURY CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7805
Mailing Address - Country:US
Mailing Address - Phone:616-676-9164
Mailing Address - Fax:
Practice Address - Street 1:632 DUXBURY CT SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-7805
Practice Address - Country:US
Practice Address - Phone:616-676-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63610003166103T00000X
MI68010148041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist