Provider Demographics
NPI:1639286644
Name:EDWARDS, BONNIE (MS, GMHS)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, GMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22901 VICKIE LN
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8783
Mailing Address - Country:US
Mailing Address - Phone:360-419-3593
Mailing Address - Fax:360-419-3505
Practice Address - Street 1:1100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4209
Practice Address - Country:US
Practice Address - Phone:360-419-3593
Practice Address - Fax:360-419-3505
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00012704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health