Provider Demographics
NPI:1336622117
Name:STREICH-HERMANSTORFER, BONITA (LMHC)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:STREICH-HERMANSTORFER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 COVENTRY LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7028
Mailing Address - Country:US
Mailing Address - Phone:319-269-2956
Mailing Address - Fax:
Practice Address - Street 1:1420 W DONALD ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1624
Practice Address - Country:US
Practice Address - Phone:319-232-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA090375OtherIOWA BOARD OF BEHAVIORAL SCIENCE