Provider Demographics
NPI:1912499518
Name:BONNETT, SHARON (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BONNETT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 3RD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2399
Mailing Address - Country:US
Mailing Address - Phone:507-343-3822
Mailing Address - Fax:507-343-3819
Practice Address - Street 1:1029 3RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2399
Practice Address - Country:US
Practice Address - Phone:507-343-3822
Practice Address - Fax:507-343-3819
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN143721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical