Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 01035 | MO |
NPI | 1013912484 |
---|---|
Provider Name | Dr. Bonnie B. Walbran |
First Address | Saint Louis, MO 63122-1615 |
Second Address | Saint Louis, MO 63122-1615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/07/2007 |