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NPI Code Detail

MEDICARE: BONNIE JOANNE VALLANCE

MEDICARE: BONNIE JOANNE VALLANCE
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
11041C0700XClinical Social Worker6801106980MA

General Provider Information

NPI Number : 1639773179
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE JOANNE VALLANCE
Provider Business Mailing Address
First Line : 2900 WATKINS RD
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49015-8604
Country : US
Telephone Number : 269-245-5467
Fax Number :
Provider Business Practice Location Address
First Line : 2900 WATKINS RD
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49015-8604
Country : US
Telephone Number : 269-245-5467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2020
Last Update Date : 01/20/2021

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Directions to “ BONNIE JOANNE VALLANCE ” Practice Location

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