MEDICARE: BONNIE M WINKLEMAN LTD

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	103TC1900X	Counseling Psychologist	PY0405	NV

General Provider Information

NPI Number	:	1376745067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONNIE M WINKLEMAN LTD

Provider Business Mailing Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:	SUITE 210 B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-448-5750
Fax Number	:	702-448-3360

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:	SUITE 210 B
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-448-5750
Fax Number	:	702-448-3360

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. CHRISTOPHER MITCHELL
Credential	:
Telephone Number	:	702-448-5750

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/29/2007

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