Provider Demographics
NPI:1609198001
Name:BONNIE B CONNOR
Entity Type:Organization
Organization Name:BONNIE B CONNOR
Other - Org Name:BONNIE CONNOR CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-265-3800
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-0190
Mailing Address - Country:US
Mailing Address - Phone:530-265-3800
Mailing Address - Fax:800-390-1612
Practice Address - Street 1:825 ZION ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2922
Practice Address - Country:US
Practice Address - Phone:530-265-3800
Practice Address - Fax:800-390-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22446103G00000X, 103TA0700X, 103TC0700X, 103TH0004X
22446103TR0400X
CA9172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty