Healthcare Provider Details

I. General information

NPI: 1912995523
Provider Name (Legal Business Name): BONNI L. KLINGERMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PAUL ST
ASHLAND PA
17921-9508
US

IV. Provider business mailing address

24 PAUL ST
ASHLAND PA
17921-9508
US

V. Phone/Fax

Practice location:
  • Phone: 570-875-3241
  • Fax: 570-875-3657
Mailing address:
  • Phone: 570-875-3241
  • Fax: 570-875-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS005600L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: