Healthcare Provider Details

I. General information

NPI: 1184783698
Provider Name (Legal Business Name): KATHLEEN A BONIE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 WILMINGTON AVE
DAYTON OH
45420
US

IV. Provider business mailing address

1136 WILMINGTON AVE
DAYTON OH
45420
US

V. Phone/Fax

Practice location:
  • Phone: 937-254-6700
  • Fax: 937-254-6776
Mailing address:
  • Phone: 937-254-6700
  • Fax: 937-254-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: