Provider Demographics
NPI:1912995523
Name:KLINGERMAN, BONNI L (MA)
Entity Type:Individual
Prefix:MRS
First Name:BONNI
Middle Name:L
Last Name:KLINGERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-9508
Mailing Address - Country:US
Mailing Address - Phone:570-875-3241
Mailing Address - Fax:570-875-3657
Practice Address - Street 1:24 PAUL ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:PA
Practice Address - Zip Code:17921-9508
Practice Address - Country:US
Practice Address - Phone:570-875-3241
Practice Address - Fax:570-875-3657
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005600L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKL664405Medicare ID - Type Unspecified