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General NPI Number Information
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NPI Number | 1215087572
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Entity Type | Individual
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Provider Name | SANDRA HOPE BONDELIER LISW-S AND LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 242 SHAKE RAG RD
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City | CLINTON
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State | AR
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Zip | 72031-6629
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Country | US
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Telephone | 419-261-6818
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Fax |
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Provider Business Mailing Address
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Address Line | 261 LAKEVIEW DR
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City | FAIRFIELD BAY
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State | AR
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Zip | 72088-2708
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Country | US
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Telephone | 419-261-6818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I4083
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7246-C
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License Number State | AR
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