Individual
BONNIE LEE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
241 CLEVELAND AVE S, SUITE P, SAINT PAUL, MN 55105-1208
(651) 690-3808
Mailing address
241 CLEVELAND AVE S, SUITE P, SAINT PAUL, MN 55105-1208
(651) 690-3808
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1053
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104210
UCARE
MN
05
—
358047400
—
MN
01
—
43184GR
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/05/2006
Last updated
11/27/2012
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