Provider Demographics
NPI:1285042002
Name:BOND, KEN D JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:D
Last Name:BOND
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:D
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:33007 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3429
Mailing Address - Country:US
Mailing Address - Phone:405-214-0116
Mailing Address - Fax:877-334-8552
Practice Address - Street 1:1127 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-4845
Practice Address - Country:US
Practice Address - Phone:405-214-0116
Practice Address - Fax:877-334-8552
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1104103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist