Provider Demographics
NPI:1043204563
Name:CONNOLLY, BONNIE L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 1/2 W GENEVA ST
Mailing Address - Street 2:CREDENCE THERAPY ASSOCIATES
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1722
Mailing Address - Country:US
Mailing Address - Phone:262-723-3424
Mailing Address - Fax:262-723-8308
Practice Address - Street 1:1 1/2 W GENEVA ST
Practice Address - Street 2:CREDENCE THERAPY ASSOCIATES
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1722
Practice Address - Country:US
Practice Address - Phone:262-723-3424
Practice Address - Fax:262-723-8308
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILI2718125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39799400OtherHIRSP
1059860OtherCIGNA
WI39799400OtherCENPATICO
WI13042OtherDEAN CARE
WI39799400Medicaid