=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083705271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BONNIE LEE DANIELS MSW LISW-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 08/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 MT. ZION RD NW
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-9512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-654-8718
-----------------------------------------------------
Fax | 740-654-8718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 695 MT. ZION RD NW
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-9512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-654-8718
-----------------------------------------------------
Fax | 740-654-8718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I0009719
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------