Healthcare Provider Details

I. General information

NPI: 1801923339
Provider Name (Legal Business Name): DR. BONNIE MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. BONNIE MARIE WINKLEMAN

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E MT GARFIELD RD STE 135
MUSKEGON MI
49444-7732
US

IV. Provider business mailing address

2780 S JONES BLVD SUITE 108
LAS VEGAS NV
89146-5628
US

V. Phone/Fax

Practice location:
  • Phone: 231-799-8880
  • Fax: 231-799-8803
Mailing address:
  • Phone: 888-320-2271
  • Fax: 888-765-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0405
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY0405
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301017020
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301017020
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: