Provider Demographics
NPI:1932478740
Name:BOHUN, ELIZABETH CLARE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CLARE
Last Name:BOHUN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 CUMBERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2526
Mailing Address - Country:US
Mailing Address - Phone:612-871-6816
Mailing Address - Fax:
Practice Address - Street 1:5508 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2526
Practice Address - Country:US
Practice Address - Phone:612-871-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN078441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical