MEDICARE: KRISTA BONCHEFF LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477952646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA BONCHEFF LCSW

Provider Business Mailing Address
First Line	:	3736 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	501-339-1332
Fax Number	:	834-271-1422

Provider Business Practice Location Address
First Line	:	3740 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	501-339-1332
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	07/28/2025

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