Healthcare Provider Details

I. General information

NPI: 1295074334
Provider Name (Legal Business Name): ZOE BONACK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2013
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7680 GODDARD ST STE 130
COLORADO SPRINGS CO
80920-8233
US

IV. Provider business mailing address

7680 GODDARD ST STE 130
COLORADO SPRINGS CO
80920-8233
US

V. Phone/Fax

Practice location:
  • Phone: 719-323-3094
  • Fax: 719-266-1773
Mailing address:
  • Phone: 719-323-3094
  • Fax: 719-266-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4301
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4301
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4301
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4301
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: