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Deborah Lynn Bonham

Social Worker

Behavioral Health & Social Service Providers

1269 Doctors Dr, Farmington, MO 63640-2947

PECOS Enrollment

This provider is enrolled in PECOS as DEBORAH BONHAM.

Based on the most recent information from CMS, provider Deborah Lynn Bonham is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:13 AM.

Profile Details

Provider ID
1023497468
Provider Type
Individual
Full Name
Bonham, Deborah Lynn
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/19/2015
Last Updated
5/19/2015

Contact Information

Practice Location

1269 Doctors Dr, Farmington, MO 63640-2947

(573) 664-1146

(573) 664-1149

Mailing Location

1269 Doctors Dr, Farmington, MO 63640-2947

(573) 664-1146

(573) 664-1149

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 003618 Missouri

Provider Identifiers

ID	Description	Issuer
ID 003618	Description Other	Issuer LCSW LICENSE Missouri

Deborah Lynn Bonham

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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