Provider Demographics
NPI:1972267201
Name:ROSAS, BONNIEANN MARIE (ACSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIEANN
Middle Name:MARIE
Last Name:ROSAS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:MS
Other - First Name:BONNIEANN
Other - Middle Name:MARIE
Other - Last Name:SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 WIKIUP DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7776
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:160 WIKIUP DR STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7776
Practice Address - Country:US
Practice Address - Phone:510-317-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062601041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker