MEDICARE: BONNIE RACHEL SANDIFER LICDC, LSW

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	S.1904465	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.161978	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871006684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE RACHEL SANDIFER LICDC, LSW

Provider Business Mailing Address
First Line	:	789 WHITE POND DR STE C
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 WHITE POND DR STE C
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4203
Country	:	US
Telephone Number	:	866-606-4267
Fax Number	:

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

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	04/23/2021

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