Basic Information
| Provider Information | |||||||||
| NPI: | 1194120444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ILER | ||||||||
| FirstName: | BONNIE | ||||||||
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| Credential: | M.A. - LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13118 FULLMER RD | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435128859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105129872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 N PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434021335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193525387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C1400532 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | E.1800627 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.