MEDICARE: MRS. BONITA L HALE LICENSED SOCIAL WORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	33008644A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356845424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONITA L HALE LICENSED SOCIAL WORK

Provider Business Mailing Address
First Line	:	5760 ROSEMONT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5028
Country	:	US
Telephone Number	:	131-743-9779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 N HIGH SCHOOL RD STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4724
Country	:	US
Telephone Number	:	317-986-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	06/16/2018

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Directions to “ MRS. BONITA L HALE LICENSED SOCIAL WORK” Practice Location

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