Provider Demographics
NPI:1821201930
Name:KLEIN-TASMAN, BONITA P (PHD)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:P
Last Name:KLEIN-TASMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E NEWBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3651
Mailing Address - Country:US
Mailing Address - Phone:414-962-9612
Mailing Address - Fax:414-229-5219
Practice Address - Street 1:2441 E HARTFORD AVE
Practice Address - Street 2:GARLAND 210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3160
Practice Address - Country:US
Practice Address - Phone:414-229-3060
Practice Address - Fax:414-229-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2368-057103G00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities