Provider Demographics
NPI:1023032836
Name:HOLSTEIN, BONNIE DANSON SR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:DANSON
Last Name:HOLSTEIN
Suffix:SR
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 BIRCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1465
Mailing Address - Country:US
Mailing Address - Phone:541-292-7536
Mailing Address - Fax:
Practice Address - Street 1:208 OAK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1871
Practice Address - Country:US
Practice Address - Phone:541-292-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR140780OtherPTAN NUMBER FOR MEDICARE