MEDICARE: KIMBERLY BONHAM

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	101Y00000X	Counselor		DC
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1114890829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BONHAM

Provider Business Mailing Address
First Line	:	610 QUACKENBOS ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1230
Country	:	US
Telephone Number	:	301-281-5824
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 NEW HAMPSHIRE AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4734
Country	:	US
Telephone Number	:	240-470-5682
Fax Number	:

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	02/26/2026

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Directions to “ KIMBERLY BONHAM ” Practice Location

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