Provider Demographics
NPI:1952460776
Name:KENDALL, BONNIE JENE (MSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JENE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JENE
Other - Last Name:HAUSWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:705 GAGE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-627-0504
Mailing Address - Fax:509-627-0504
Practice Address - Street 1:705 GAGE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-627-0504
Practice Address - Fax:509-627-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000074621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA810603917OtherTAX IDENTIFICATION NUMBER