Provider Demographics
NPI:1306821129
Name:BETTS, BONNIE J (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:BETTS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N STATE ST
Mailing Address - Street 2:WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2811
Mailing Address - Country:US
Mailing Address - Phone:507-835-1210
Mailing Address - Fax:507-837-4280
Practice Address - Street 1:501 N STATE ST
Practice Address - Street 2:WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2811
Practice Address - Country:US
Practice Address - Phone:507-835-1210
Practice Address - Fax:507-837-4280
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN295J6BEOtherBCBS
MN295J6BEOtherMNCARE
MN323553000Medicaid
MN114939OtherMNCARE-U
MNHP28643OtherHEALTH PARTNERS
MNNA9501007681OtherPREFERRED ONE
MNP00054204OtherMEDICARE - RAILROAD
MNP00054204OtherMEDICARE - RAILROAD