Healthcare Provider Details

I. General information

NPI: 1215087572
Provider Name (Legal Business Name): SANDRA HOPE BONDELIER LISW-S AND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA HOPE REEVES LISW

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 SHAKE RAG RD
CLINTON AR
72031-6629
US

IV. Provider business mailing address

261 LAKEVIEW DR
FAIRFIELD BAY AR
72088-2708
US

V. Phone/Fax

Practice location:
  • Phone: 419-261-6818
  • Fax:
Mailing address:
  • Phone: 419-261-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4083
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7246-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: