Provider Demographics
NPI:1932260874
Name:WILLIAMS, BONNIE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:KAY
Other - Last Name:MYHRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 AMBER DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3318
Mailing Address - Country:US
Mailing Address - Phone:319-364-5106
Mailing Address - Fax:319-368-8096
Practice Address - Street 1:2516 AMBER DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3318
Practice Address - Country:US
Practice Address - Phone:319-364-5106
Practice Address - Fax:319-368-8096
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005821041C0700X
IA200106H00000X
IA5821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03522Medicare ID - Type Unspecified