Provider Demographics
NPI:1699825331
Name:HARRINGTON, BONNIE SUZE (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUZE
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:SUZE
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1415 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3724
Mailing Address - Country:US
Mailing Address - Phone:801-474-2100
Mailing Address - Fax:801-487-9336
Practice Address - Street 1:1415 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3724
Practice Address - Country:US
Practice Address - Phone:801-474-2100
Practice Address - Fax:801-487-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139847-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000007170Medicare UPIN