Provider Demographics
NPI:1982885430
Name:IVERS, BONNIE JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JEAN
Last Name:IVERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE AUTISM SPECTRUM DISORDERS CENTER
Mailing Address - Street 2:10725 INTERNATIONAL DRIVE
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-631-2561
Mailing Address - Fax:916-631-2553
Practice Address - Street 1:10725 INTERNATIONAL DR
Practice Address - Street 2:ASD
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7967
Practice Address - Country:US
Practice Address - Phone:916-631-2561
Practice Address - Fax:916-631-2553
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21391103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent