MEDICARE: NANCY H BONNER LSCSW

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	1471	KS

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	:	1861463853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY H BONNER LSCSW

Provider Business Mailing Address
First Line	:	902 W 27TH TER
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-4618
Country	:	US
Telephone Number	:	785-312-7273
Fax Number	:	785-865-1399

Provider Business Practice Location Address
First Line	:	2323 RIDGE CT
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3956
Country	:	US
Telephone Number	:	785-865-5300
Fax Number	:	785-865-1399

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	12/02/2008

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