Provider Demographics
NPI:1538412507
Name:BONNER, KELI MARIE (LSW)
Entity type:Individual
Prefix:MS
First Name:KELI
Middle Name:MARIE
Last Name:BONNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21340
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0340
Mailing Address - Country:US
Mailing Address - Phone:216-926-8879
Mailing Address - Fax:
Practice Address - Street 1:5241 WILSON MILLS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2150
Practice Address - Country:US
Practice Address - Phone:216-926-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1101277104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker