Healthcare Provider Details

I. General information

NPI: 1336052232
Provider Name (Legal Business Name): ELIZABETH BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 W CREEK RD
OZARK AR
72949-9856
US

IV. Provider business mailing address

6705 W CREEK RD
OZARK AR
72949-9856
US

V. Phone/Fax

Practice location:
  • Phone: 503-528-6496
  • Fax:
Mailing address:
  • Phone: 503-528-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: