Provider Demographics
NPI:1982230553
Name:BOHNE, SALOME INEZ
Entity Type:Individual
Prefix:
First Name:SALOME
Middle Name:INEZ
Last Name:BOHNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 NE 124TH ST # 574
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4305
Mailing Address - Country:US
Mailing Address - Phone:206-883-6049
Mailing Address - Fax:
Practice Address - Street 1:19201 120TH AVE NE STE 108
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9523
Practice Address - Country:US
Practice Address - Phone:425-485-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609857881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical