Individual
DR. IAN BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5315 N CLARK ST # 215, CHICAGO, IL 60640-2290
(908) 229-3578
Mailing address
5315 N CLARK ST # 215, CHICAGO, IL 60640-2290
(908) 229-3578
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.008712
IL
Other
Enumeration date
12/11/2013
Last updated
08/31/2020
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