Basic Information
| Provider Information | |||||||||
| NPI: | 1174887533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONOW | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | A C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD, BCBA-D, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13010 NE 20TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980052034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256446328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2435 PYRAMID WAY STE B | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894311865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756578309 | ||||||||
| FaxNumber: | 7756578359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2012 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | LBA0006 | NV | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.