MEDICARE: CHRISTOPHER WALLACE BONNER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	986087	CO

General Provider Information

NPI Number	:	1033303342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER WALLACE BONNER MSW

Provider Business Mailing Address
First Line	:	1403 GREENWOOD AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-2329
Country	:	US
Telephone Number	:	615-942-8076
Fax Number	:	615-366-1351

Provider Business Practice Location Address
First Line	:	1403 GREENWOOD AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-2329
Country	:	US
Telephone Number	:	615-942-8076
Fax Number	:	615-366-1351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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