Individual
BONITA JEAN DEBBAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
970 S SILVER LAKE ST, OCONOMOWOC, WI 53066-3802
(262) 567-7900
(262) 567-7908
Mailing address
970 S SILVER LAKE ST, OCONOMOWOC, WI 53066-3802
(262) 567-7900
(262) 567-7908
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2324-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
412024650011
BLUE CROSS BLUE SHIELD
WI
05
—
43550000
—
WI
Enumeration date
05/20/2006
Last updated
07/08/2007
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