Provider Demographics
NPI:1780315879
Name:FRALEY, BONITA (CDCA)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:FRALEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4842
Mailing Address - Country:US
Mailing Address - Phone:419-771-3216
Mailing Address - Fax:
Practice Address - Street 1:2727 HARDING HWY
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3433
Practice Address - Country:US
Practice Address - Phone:419-221-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist