Individual
DR. NELLY ESTHER BONILLA BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
863 FOREST EDGE DR, JORDAN, MN 55352-4502
(612) 475-0505
Mailing address
863 FOREST EDGE DR, JORDAN, MN 55352-4502
(612) 475-0505
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6839
PR
Other
Enumeration date
05/07/2018
Last updated
09/19/2024
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