Provider Demographics
NPI:1780613786
Name:KAUFFMANN, BONNIE L (PHD)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:L
Last Name:KAUFFMANN
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 1:2525 GEORGETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4303
Mailing Address - Country:US
Mailing Address - Phone:419-474-8412
Mailing Address - Fax:419-472-8675
Practice Address - Street 1:4125 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2064
Practice Address - Country:US
Practice Address - Phone:419-472-7330
Practice Address - Fax:419-472-8675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000139911Medicare UPIN