Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 33007045A | IN |
NPI | 1003207614 |
---|---|
Provider Name | Kyle W Bonham |
First Address | Indianapolis, IN 46202-1261 |
Second Address | Indianapolis, IN 46202-1261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2015 |
Last Update Date | 18/02/2015 |