Individual
LORA ELIZABETH BONHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2776 W LIZZI CV, SOUTH JORDAN, UT 84095-7961
(801) 631-9980
Mailing address
2776 W LIZZI CV, SOUTH JORDAN, UT 84095-7961
(801) 631-9980
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9806232-3501
UT
1041S0200X
School Social Worker
683825
UT
Other
Enumeration date
06/27/2019
Last updated
06/27/2019
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