Dr. Nelly Esther Bonilla Bonilla, PsyD, LP
Psychologist in Jordan, MN. Individual provider (NPI-1).
NPI number1356830210
StatusActive
Last updated in NPPESSep 19, 2024
Details
- NPI
- 1356830210
- Entity type
- Individual (NPI-1)
- Name
- Dr. Nelly Esther Bonilla Bonilla
- Credential
- PsyD, LP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 7, 2018
- Certification date
- Sep 19, 2024
- Last updated
- Sep 19, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | LP6839 | PR | Yes |
Practice location
863 Forest Edge DrJordan, MN 55352-4502
Phone 612-475-0505
Mailing address
863 Forest Edge DrJordan, MN 55352-4502
Phone 612-475-0505
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