Healthcare Provider Details

I. General information

NPI: 1306821129
Provider Name (Legal Business Name): BONNIE J. BETTS PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N STATE ST WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
WASECA MN
56093-2811
US

IV. Provider business mailing address

501 N STATE ST WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
WASECA MN
56093-2811
US

V. Phone/Fax

Practice location:
  • Phone: 507-835-1210
  • Fax: 507-837-4280
Mailing address:
  • Phone: 507-835-1210
  • Fax: 507-837-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0873
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: