Provider Demographics
NPI:1942622782
Name:BONSER, BELINDY (CSWA A14872)
Entity Type:Individual
Prefix:
First Name:BELINDY
Middle Name:
Last Name:BONSER
Suffix:
Gender:F
Credentials:CSWA A14872
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 FAIRWEATHER DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1591
Mailing Address - Country:US
Mailing Address - Phone:541-531-7929
Mailing Address - Fax:
Practice Address - Street 1:107 E MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-6022
Practice Address - Country:US
Practice Address - Phone:541-531-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
ORA148721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13-CRM-070OtherACCBO