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General NPI Number Information
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NPI Number | 1942771712
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Entity Type | Individual
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Provider Name | MR. JOHN DAVID BUNNELL
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Gender | Male
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 400 LAKE ST STE 216
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City | ROSELLE
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State | IL
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Zip | 60172-3572
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Country | US
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Telephone | 630-449-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 855 HUNTER DR
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City | ROSELLE
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State | IL
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Zip | 60172-1807
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Country | US
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Telephone |
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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 | 149.006714
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License Number State | IL
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