Provider Demographics
NPI:1952324279
Name:RAJALA, BONITA JEAN (RN LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:JEAN
Last Name:RAJALA
Suffix:
Gender:F
Credentials:RN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 EAST GRANT ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-5353
Mailing Address - Fax:815-432-5353
Practice Address - Street 1:617 EAST GRANT ST.
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970
Practice Address - Country:US
Practice Address - Phone:815-432-5353
Practice Address - Fax:815-432-5353
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse