Provider Demographics
NPI:1023090792
Name:LEROY, BONNIE SUSAN (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUSAN
Last Name:LEROY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2641
Mailing Address - Country:US
Mailing Address - Phone:612-624-7193
Mailing Address - Fax:612-625-4490
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 485, UNIVERSITY OF MINNESOTA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-624-7193
Practice Address - Fax:612-625-4490
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS