Provider Demographics
NPI:1487606836
Name:WALKER, BONNIE JEAN (LISW)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 BETA DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2363
Mailing Address - Country:US
Mailing Address - Phone:440-446-9696
Mailing Address - Fax:440-449-1435
Practice Address - Street 1:6700 BETA DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2363
Practice Address - Country:US
Practice Address - Phone:440-446-9696
Practice Address - Fax:440-449-1435
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWASW26382Medicare ID - Type UnspecifiedL.I.S.W