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NPI Code Detail

MEDICARE: DR. RONALD DEAN BONJEAN PH.D.

MEDICARE: DR. RONALD DEAN BONJEAN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor604-125WI

General Provider Information

NPI Number : 1194880542
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD DEAN BONJEAN PH.D.
Provider Business Mailing Address
First Line : 3920 N DOWNER AVE
Second Line :
City : SHOREWOOD
State : WI
Zip : 53211-2466
Country : US
Telephone Number : 414-964-7493
Fax Number :
Provider Business Practice Location Address
First Line : 1524 N FARWELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-2329
Country : US
Telephone Number : 414-273-2220
Fax Number : 414-273-2223
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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