Provider Demographics
NPI:1790763803
Name:BOND, TRUDY (EDD)
Entity Type:Individual
Prefix:DR
First Name:TRUDY
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1367
Mailing Address - Country:US
Mailing Address - Phone:419-536-3356
Mailing Address - Fax:419-536-9709
Practice Address - Street 1:3131 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1367
Practice Address - Country:US
Practice Address - Phone:419-536-3356
Practice Address - Fax:419-536-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2978103TC1900X
MI3786103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454173Medicaid
OHBOCP04151Medicare PIN