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Individual
JEFFREY TROY BONDORA
Active
Individual
JEFFREY TROY BONDORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.012821
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633897
BCBS GROUP NUMBER
IL
01
—
1679546873
GROUP NPI NUMBER
IL
01
—
207844
MEDICARE GROUP NUMBER
IL
Enumeration date
07/09/2008
Last updated
06/24/2013
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