| Doctor Name: | MS. BONNIE KAY ELLINGBOE |
| NPI Number: | 1215015789 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LP |
| License Number: | MN3177 |
| Business Practice Address: | 901 Twelve Oaks Center Dr Suite 926 C Wayzata, MN - 553914701 |
| Business Phone Number: | 6122370956 |
| Business Fax Number: | 7635464971 |
| Mailing Address: | 10120 29th Ave N, PLYMOUTH |
| State: | MN |
| Postal Code: | 55441 |
| Phone Number: | 7635465407 |
| Fax Number: | 7635464971 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/30/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | MN3177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |