Healthcare Provider Details

I. General information

NPI: 1912951708
Provider Name (Legal Business Name): BONNIE L FRASER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 DARROW ROAD SUITE 101
STOW OH
44224-1411
US

IV. Provider business mailing address

4833 DARROW ROAD SUITE 101
STOW OH
44224-1411
US

V. Phone/Fax

Practice location:
  • Phone: 330-650-5338
  • Fax: 330-342-3837
Mailing address:
  • Phone: 330-650-5338
  • Fax: 330-342-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2908
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY6357
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2908
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2908
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: