| Doctor Name: | MS. BONITA SHUFFAIN SIEGEL |
| NPI Number: | 1629050745 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | |
| Business Practice Address: | 15029 Bothell Way Ne Suite 300 Lake Forest Park, WA - 981557663 |
| Business Phone Number: | 2063640075 |
| Business Fax Number: | 2063647607 |
| Mailing Address: | 15029 Bothell Way Ne, Suite 300 LAKE FOREST PARK |
| State: | WA |
| Postal Code: | 981557663 |
| Phone Number: | 2063640075 |
| Fax Number: | 2063647607 |
| NPI Enumeration Date: | 11/15/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |