Individual
MS. MARY ELISABETH BONNESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LPC NCC
Contact information
Practice address
2500 N MAYFAIR RD, SUITE # 560, WAUWATOSA, WI 53226
(414) 771-5002
(414) 771-2928
Mailing address
2500 N MAYFAIR RD, SUITE # 560, WAUWATOSA, WI 53226
(414) 771-5002
(414) 771-2928
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2639125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11570477
CA QH PROVIDER ID
—
01
—
167018
MANAGED HEALTH NETWORK
—
Enumeration date
09/11/2006
Last updated
07/08/2007
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