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General NPI Number Information
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NPI Number | 1396941928
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Entity Type | Organization
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Legal Business Name | BONNIE KRUEGER, PH.D.
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 5015 EAGLE ROCK BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90041-2085
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Country | US
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Telephone | 323-356-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 1567 HAZELWOOD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90041-3315
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Country | US
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Telephone | 323-356-4577
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. BONNIE KRUEGER
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Credential | PH.D.
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Telephone | 323-356-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16400
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License Number State | CA
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