Provider Demographics
NPI:1083826424
Name:RUDDEN, BONNIE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MARIE
Last Name:RUDDEN
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 1:102 SHEFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3323
Mailing Address - Country:US
Mailing Address - Phone:314-594-8081
Mailing Address - Fax:636-463-2849
Practice Address - Street 1:13422 CLAYTON RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-594-8081
Practice Address - Fax:636-463-2848
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health