MEDICARE: DR. STEPHANIE J BONO PHD

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	2019045098	MO

General Provider Information

NPI Number	:	1801471412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE J BONO PHD

Provider Business Mailing Address
First Line	:	10820 SUNSET OFFICE DR STE 220
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-252-8949
Fax Number	:	314-228-0833

Provider Business Practice Location Address
First Line	:	10820 SUNSET OFFICE DR STE 220
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1030
Country	:	US
Telephone Number	:	314-252-8949
Fax Number	:	314-228-0833

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	08/30/2024

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