Provider Demographics
NPI:1457331563
Name:EIDENS, BONNIE L (MSSA, LISW, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:EIDENS
Suffix:
Gender:F
Credentials:MSSA, LISW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9146
Mailing Address - Country:US
Mailing Address - Phone:440-813-5071
Mailing Address - Fax:
Practice Address - Street 1:850 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9146
Practice Address - Country:US
Practice Address - Phone:440-813-5071
Practice Address - Fax:440-992-7887
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHEISW24584Medicare ID - Type Unspecified