Provider Demographics
NPI:1821604968
Name:BOHNERT, MIRIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BOHNERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 CHAMPIONSHIP LN
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-5629
Mailing Address - Country:US
Mailing Address - Phone:573-953-8899
Mailing Address - Fax:
Practice Address - Street 1:1837 CHAMPIONSHIP LN
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-5629
Practice Address - Country:US
Practice Address - Phone:573-953-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190426121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical