Provider Demographics
NPI:1780624890
Name:FLOYD, BONNIE J (PHD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:J
Last Name:FLOYD
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 1:1920 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4988
Mailing Address - Country:US
Mailing Address - Phone:630-792-1343
Mailing Address - Fax:630-576-5553
Practice Address - Street 1:1920 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4988
Practice Address - Country:US
Practice Address - Phone:630-792-1343
Practice Address - Fax:630-576-5553
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623169OtherBC/BS PROVIDER ID
ILK33733Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL21623169OtherBC/BS PROVIDER ID
IL705050Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
IL211904Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER