Healthcare Provider Details

I. General information

NPI: 1295118461
Provider Name (Legal Business Name): LONI A NELSON-BOUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 N SOUND DR
SEDRO WOOLLEY WA
98284-7697
US

IV. Provider business mailing address

1803 N SOUND DR
SEDRO WOOLLEY WA
98284-7697
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7400
  • Fax: 360-854-7446
Mailing address:
  • Phone: 360-854-7400
  • Fax: 360-854-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: