Provider Demographics
NPI:1871990762
Name:MCKEEGAN, BONNIE A (LCSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:A
Last Name:MCKEEGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:A
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:17076 JODY CT
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7208
Mailing Address - Country:US
Mailing Address - Phone:530-559-8406
Mailing Address - Fax:530-615-0114
Practice Address - Street 1:17076 JODY CT
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7208
Practice Address - Country:US
Practice Address - Phone:530-559-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS233441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871990762Medicaid
CA1871990762Medicaid