Provider Demographics
NPI:1821541574
Name:SHELTON, BONNIE KATHERINE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:KATHERINE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8858 POSSUM HILL RD
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62097-1020
Mailing Address - Country:US
Mailing Address - Phone:618-541-2886
Mailing Address - Fax:
Practice Address - Street 1:8858 POSSUM HILL RD
Practice Address - Street 2:
Practice Address - City:WORDEN
Practice Address - State:IL
Practice Address - Zip Code:62097-1020
Practice Address - Country:US
Practice Address - Phone:618-541-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490260531041C0700X
IL057.004002224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant