Individual
MARK ELDON BONTREGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
525 5TH ST SE, SUITE L-13, WATERTOWN, SD 57201-4940
(605) 882-0800
(605) 882-0861
Mailing address
525 5TH ST SE, SUITE L-13, WATERTOWN, SD 57201-4940
(605) 882-0800
(605) 882-0861
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
364
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6551792
—
SD
Enumeration date
08/17/2006
Last updated
11/02/2007
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