Provider Demographics
NPI:1881649481
Name:BONNETT, SHEILA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KAY
Last Name:BONNETT
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 1:2500 E SHOW LOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7929
Mailing Address - Country:US
Mailing Address - Phone:928-537-2951
Mailing Address - Fax:928-537-8520
Practice Address - Street 1:2500 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7929
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:928-537-8520
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW108941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ942723OtherAHCCCS