Provider Demographics
NPI:1811302078
Name:WILLIAMS, BONNIE (LSW)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1540
Mailing Address - Country:US
Mailing Address - Phone:701-947-5314
Mailing Address - Fax:701-947-2960
Practice Address - Street 1:22 9TH ST S
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1540
Practice Address - Country:US
Practice Address - Phone:701-947-5314
Practice Address - Fax:701-947-2960
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3721104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND$$$$$$$$$OtherSSN