MEDICARE: BONNIE SCHWENDER MS, MA

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	103T00000X	Psychologist	01800	MO

General Provider Information

NPI Number	:	1912906652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SCHWENDER MS, MA

Provider Business Mailing Address
First Line	:	5000 CEDAR PLAZA PARKWAY
Second Line	:	STE 350
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3441
Country	:	US
Telephone Number	:	314-843-4333
Fax Number	:	314-843-4856

Provider Business Practice Location Address
First Line	:	2900 LEMAY FERRY RD
Second Line	:	SUITE 221
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3900
Country	:	US
Telephone Number	:	314-892-0667
Fax Number	:	314-892-0921

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/12/2007

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