Provider Demographics
NPI:1891703203
Name:WHALEN, BONNIE PENNINGTON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:PENNINGTON
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13830 METCALF AVE APT 15003
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-8024
Mailing Address - Country:US
Mailing Address - Phone:913-345-2137
Mailing Address - Fax:913-345-2135
Practice Address - Street 1:9500 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3902
Practice Address - Country:US
Practice Address - Phone:816-820-6133
Practice Address - Fax:913-345-2137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30773014OtherBLUE CROSS BLUE SHIELD
219563OtherCOM PSYCH