Provider Demographics
NPI:1619105699
Name:BONNIE EIDENS LISW, CEAP, LLC
Entity Type:Organization
Organization Name:BONNIE EIDENS LISW, CEAP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:EIDENS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, CEAP
Authorized Official - Phone:440-813-5071
Mailing Address - Street 1:850 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9146
Mailing Address - Country:US
Mailing Address - Phone:440-813-5071
Mailing Address - Fax:440-466-0969
Practice Address - Street 1:850 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9146
Practice Address - Country:US
Practice Address - Phone:440-813-5071
Practice Address - Fax:440-466-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty