Doctor Name: | BONNIE L CARLSON-GREEN |
NPI Number: | 1063471506 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD LP |
License Number: | LP3309 |
Business Practice Address: | 347 North Smith Avenue Childrens Specialty Clinic Psychological Services Stpl St Paul, MN - 55102 |
Business Phone Number: | 6512206720 |
Business Fax Number: | 6512206707 |
Mailing Address: | 2910 Centre Pointe Drive, 35-121a Childrens Health Care ROSEVILLE |
State: | MN |
Postal Code: | 55113 |
Phone Number: | 6518552327 |
Fax Number: | 6518552310 |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | LP3309 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |