Healthcare Provider Details

I. General information

NPI: 1316467061
Provider Name (Legal Business Name): AMY R BONEBRAKE LMSW, CADC, SAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CANTERBURY CT
WATERLOO IA
50702-5705
US

IV. Provider business mailing address

4819 GREENBELT DR
CEDAR FALLS IA
50613-9619
US

V. Phone/Fax

Practice location:
  • Phone: 319-252-4631
  • Fax: 319-252-4631
Mailing address:
  • Phone: 319-243-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number09007
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109128
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: