Provider Demographics
NPI:1780740027
Name:REITZEL, BONNIE DELOE
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:DELOE
Last Name:REITZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 E UNIVERSITY DR
Mailing Address - Street 2:#1009
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6925
Mailing Address - Country:US
Mailing Address - Phone:602-909-8375
Mailing Address - Fax:
Practice Address - Street 1:3716 E UNIVERSITY DR
Practice Address - Street 2:#1009
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6925
Practice Address - Country:US
Practice Address - Phone:602-909-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8092385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child