Provider Demographics
NPI:1275070799
Name:CHANG, BONNY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SW TRENTON ST # 1108
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3206
Mailing Address - Country:US
Mailing Address - Phone:732-703-6880
Mailing Address - Fax:
Practice Address - Street 1:3250 AIRPORT WAY S STE 530
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2111
Practice Address - Country:US
Practice Address - Phone:732-703-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2023-04-03
Deactivation Date:2019-03-30
Deactivation Code:
Reactivation Date:2019-12-12
Provider Licenses
StateLicense IDTaxonomies
WA60704331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist