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General NPI Number Information
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NPI Number | 1013912484
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Entity Type | Individual
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Provider Name | BONNIE B. WALBRAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 859 EDLIN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1615
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Country | US
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Telephone | 314-607-8181
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Fax | 314-822-5431
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Provider Business Mailing Address
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Address Line | 859 EDLIN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1615
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Country | US
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Telephone | 314-607-8181
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Fax | 314-822-5431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 01035
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License Number State | MO
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