Provider Demographics
NPI:1952405987
Name:BONDE, FARRAH (LISW)
Entity Type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:
Last Name:BONDE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MISS
Other - First Name:FARRAH
Other - Middle Name:
Other - Last Name:LUCKRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:612 REDBIRD RUN
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4806
Practice Address - Country:US
Practice Address - Phone:319-338-2722
Practice Address - Fax:319-338-7758
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical