Provider Demographics
NPI:1629050745
Name:SIEGEL, BONITA SHUFFAIN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:SHUFFAIN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BONITA
Other - Middle Name:SHUFFAIN
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:15029 BOTHELL WAY NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7663
Mailing Address - Country:US
Mailing Address - Phone:206-364-0075
Mailing Address - Fax:206-364-7607
Practice Address - Street 1:15029 BOTHELL WAY NE
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-7663
Practice Address - Country:US
Practice Address - Phone:206-364-0075
Practice Address - Fax:206-364-7607
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00004023OtherSOCIAL WORKER LICENSE #
WALW00004023OtherSOCIAL WORKER LICENSE #