Provider Demographics
NPI:1477108231
Name:BONNER, DEVON ELAINE (SCM LCGC)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:ELAINE
Last Name:BONNER
Suffix:
Gender:F
Credentials:SCM LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 QUARRY RD # 5660
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1419
Mailing Address - Country:US
Mailing Address - Phone:650-725-7254
Mailing Address - Fax:650-498-4555
Practice Address - Street 1:300 PASTEUR DR # H-315
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-725-7254
Practice Address - Fax:650-498-8882
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000844170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS