Provider Demographics
NPI:1073780094
Name:HEDLUND, BONNIE LEE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LEE
Last Name:HEDLUND
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 254
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-282-8310
Mailing Address - Fax:949-472-0307
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 254
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-282-8310
Practice Address - Fax:949-472-0307
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical