Misty M Bonham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L11217 Issued in OR

Practice address

358 NW 1St Ave Ste 3
Canby, OR 97013-3533

Phone

(503) 427-8255

Fax

(971) 377-2995

NPI assigned

Jun 5, 2019

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Barbara Majors LLC

  • Adult Mental Health Clinic/Center
  • Milwaukie, OR
  • NPI 1104323245

  OR

  Medicare reassignment Care Compare group

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Barbara Majors LLC 9 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 16, 2023.

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1467010397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 755",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970130755",
            "telephone_number": "503-427-8255",
            "fax_number": "971-377-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 NW 1ST AVE STE 3",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970133533",
            "telephone_number": "503-427-8255",
            "fax_number": "971-377-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONHAM",
        "first_name": "MISTY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2023-10-16",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Bissig, DPT
• Anna Fehm Blake, RN
• Dianne Eileen Blust, ANP
• Tyler Marc Bohnet, MPT
• Gary M Bold, RPH
• Briana Nichole Booth
• Zachary Borden
• Sihely Borycens
• Bountiful Health Family Medicine, LLC
• Kathryn Eileen Brandt, M.S., CFY-SLP

• All providers in Canby, OR
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.