Doctor Name: | MRS. BONNIE L CONNOLLY |
NPI Number: | 1043204563 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LI2718125 |
Business Practice Address: | 1 1/2 W Geneva St Credence Therapy Associates Elkhorn, WI - 531211722 |
Business Phone Number: | 2627233424 |
Business Fax Number: | 2627238308 |
Mailing Address: | 1 1/2 W Geneva St, Credence Therapy Associates ELKHORN |
State: | WI |
Postal Code: | 531211722 |
Phone Number: | 2627233424 |
Fax Number: | 2627238308 |
NPI Enumeration Date: | 09/12/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LI2718125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |