Healthcare Provider Details

I. General information

NPI: 1609198001
Provider Name (Legal Business Name): BONNIE B CONNOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 10/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 ZION ST
NEVADA CITY CA
95959-2922
US

IV. Provider business mailing address

PO BOX 190
NEVADA CITY CA
95959-0190
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-3800
  • Fax: 800-390-1612
Mailing address:
  • Phone: 530-265-3800
  • Fax: 800-390-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number22446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22446
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number22446
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number22446
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number9172
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number22446
License Number StateCA

VIII. Authorized Official

Name: DR. BONNIE B CONNOR
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 530-265-3800