Bonnie Gray Ennis, LCSW, LAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW.09924423 Issued in CO

Practice address

8989 Huron St
Thornton, CO 80260-6858

Phone

(303) 322-1056

NPI assigned

Dec 12, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1134527724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 HURON ST APT 11-106",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802604343",
            "telephone_number": "303-322-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8989 HURON ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802606858",
            "telephone_number": "303-322-1056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3712 W Princeton Cir",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802363110",
            "country_code": "US",
            "telephone_number": "303-761-2885",
            "fax_number": "303-761-1450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "BONNIE",
        "middle_name": "GRAY",
        "credential": "LCSW, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-12",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09924423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Thornton, CO
• Providers in Thornton, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.