MEDICARE: MS. BONNIE KRAFT LCSW

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	149.013020	IL

General Provider Information

NPI Number	:	1821324138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNIE KRAFT LCSW

Provider Business Mailing Address
First Line	:	2016 BRADLEY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1258
Country	:	US
Telephone Number	:	815-399-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 BRADLEY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1258
Country	:	US
Telephone Number	:	815-399-0009
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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