Provider Demographics
NPI:1093051633
Name:THACKER, BONNY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNY
Middle Name:ELIZABETH
Last Name:THACKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BONNY
Other - Middle Name:ELIZABETH
Other - Last Name:STRASSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1588
Practice Address - Country:US
Practice Address - Phone:573-437-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-01
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006401103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral