MEDICARE: MRS. BONNIE SUE CRIPE PHD LMSW ACSW DAPA

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	6801035189	MI

General Provider Information

NPI Number	:	1821219882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE SUE CRIPE PHD LMSW ACSW DAPA

Provider Business Mailing Address
First Line	:	18554 NORTHLAND DRIVE
Second Line	:
City	:	BIG RAPIDS
State	:	MI
Zip	:	49307-8788
Country	:	US
Telephone Number	:	231-592-8090
Fax Number	:	231-796-3184

Provider Business Practice Location Address
First Line	:	18554 NORTHLAND DR
Second Line	:
City	:	BIG RAPIDS
State	:	MI
Zip	:	49307-8788
Country	:	US
Telephone Number	:	231-592-8090
Fax Number	:	231-796-3184

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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