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General NPI Number Information
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NPI Number | 1699269423
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Entity Type | Individual
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Provider Name | HEATHER CHRISTINE BONETTI MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 100 POLK COUNTY PLZ STE 50
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City | BALSAM LAKE
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State | WI
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Zip | 54810-9097
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Country | US
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Telephone | 651-208-5442
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Fax |
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Provider Business Mailing Address
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Address Line | 37887 HAWTHORNE AVE
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City | NORTH BRANCH
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State | MN
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Zip | 55056-5989
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6708-125
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License Number State | WI
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