Healthcare Provider Details

I. General information

NPI: 1598703175
Provider Name (Legal Business Name): BONNIE CREECH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNION ST STE 9
BANGOR ME
04401-3039
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-972-7005
  • Fax: 207-973-8276
Mailing address:
  • Phone: 207-973-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS1143
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: