MEDICARE: DR. ZOE BONACK PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4301	CO
2	106H00000X	Marriage & Family Therapist	4301	CO
3	103T00000X	Psychologist	4301	CO
4	103G00000X	Clinical Neuropsychologist
5	103TC1900X	Counseling Psychologist	4301	CO

General Provider Information

NPI Number	:	1295074334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZOE BONACK PSYD

Provider Business Mailing Address
First Line	:	7680 GODDARD ST STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-323-3094
Fax Number	:	719-266-1773

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-323-3094
Fax Number	:	719-266-1773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2013
Last Update Date	:	03/30/2026

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