Provider Demographics
NPI:1578835518
Name:BECKSTROM, BONNIE JANE (LADC, CCDCIII)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JANE
Last Name:BECKSTROM
Suffix:
Gender:F
Credentials:LADC, CCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2127
Mailing Address - Country:US
Mailing Address - Phone:308-762-7177
Mailing Address - Fax:308-762-6121
Practice Address - Street 1:419 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2127
Practice Address - Country:US
Practice Address - Phone:308-762-7177
Practice Address - Fax:308-762-6121
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE854101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)