Provider Demographics
NPI:1750424289
Name:ALLEN, BONNIE ELIZABETH (BS)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:405-858-2733
Mailing Address - Fax:405-858-2810
Practice Address - Street 1:2322 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1903
Practice Address - Country:US
Practice Address - Phone:405-372-7662
Practice Address - Fax:405-372-3632
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10OtherCOUNSELOR