Healthcare Provider Details

I. General information

NPI: 1538164256
Provider Name (Legal Business Name): GIOVANNI M. BONDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WHITE ALLEN AVE
DAYTON OH
45405-4932
US

IV. Provider business mailing address

529 W GRAND AVE
DAYTON OH
45405-4408
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-7962
  • Fax: 937-277-6067
Mailing address:
  • Phone: 937-277-7962
  • Fax: 937-277-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: