Provider Demographics
NPI:1952460776
Name:KENDALL, BONNIE JENE (LCSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JENE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JENE
Other - Last Name:HAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8524 W GAGE BLVD STE A-111
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8241
Mailing Address - Country:US
Mailing Address - Phone:509-627-0504
Mailing Address - Fax:509-627-0504
Practice Address - Street 1:8524 W GAGE BLVD STE A-111
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8241
Practice Address - Country:US
Practice Address - Phone:509-627-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW122495104100000X
ORL84371041C0700X
WALW000074621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA810603917OtherTAX IDENTIFICATION NUMBER