MEDICARE: BONNY REID MSW, IBCLC

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	P023515	NC

General Provider Information

NPI Number	:	1720366610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNY REID MSW, IBCLC

Provider Business Mailing Address
First Line	:	615 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-6431
Country	:	US
Telephone Number	:	910-202-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 CREEDMOOR RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-4397
Country	:	US
Telephone Number	:	910-202-3155
Fax Number	:

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

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	03/12/2026

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