=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194345702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN BONDI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2020
-----------------------------------------------------
Last Update Date | 11/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 21ST AVE STE 113
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-834-9369
-----------------------------------------------------
Fax | 303-834-9369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3019 17TH AVE APT 4
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80503-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-208-6893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ACC.0021097
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------