MEDICARE: MRS. ELIZABETH J GOODSITE BONDY LPC

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	101YM0800X	Mental Health Counselor	E.0700352	OH
2	101YP2500X	Professional Counselor	5931-125	WI

General Provider Information

NPI Number	:	1881921179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH J GOODSITE BONDY LPC

Provider Business Mailing Address
First Line	:	N63W23524 SILVER SPRING DR
Second Line	:	SUITE 1
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-204-2430
Fax Number	:

Provider Business Practice Location Address
First Line	:	N63W23524 SILVER SPRING DR
Second Line	:	SUITE 1
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-204-2430
Fax Number	:

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	06/10/2016

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