MEDICARE: MRS. BONNIE L EIDENS MSSA, LISW, CEAP

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	104100000X	Social Worker	I0009169	OH

General Provider Information

NPI Number	:	1457331563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE L EIDENS MSSA, LISW, CEAP

Provider Business Mailing Address
First Line	:	850 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	440-813-5071
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	440-813-5071
Fax Number	:	440-992-7887

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/23/2009

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