Active NPI
Bonnie B. Walbran, PH.D.
- Rehabilitation Psychologist
- Saint Louis, MO
National Provider Identifier
1013912484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- License
- 01035
- Practice address
- 859 Edlin Dr
Saint Louis, MO 63122-1615 - Phone
- (314) 607-8181
- Fax
- (314) 822-5431
- NPI assigned
- Jun 14, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | 01035 | MO | Primary |
Addresses
Primary practice location
859 Edlin Dr
Saint Louis, MO 63122-1615
Mailing address
859 Edlin Dr
Saint Louis, MO 63122-1615
Phone (314) 607-8181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090123000501 | MO | Practitioner - Clinical Psychologist | 6103980883 | Practice locations: Saint Louis, MO |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01035 | MO | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1013912484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "859 EDLIN DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631221615",
"telephone_number": "314-607-8181",
"fax_number": "314-822-5431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "859 EDLIN DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631221615",
"telephone_number": "314-607-8181",
"fax_number": "314-822-5431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALBRAN",
"first_name": "BONNIE",
"middle_name": "B.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "MO",
"license": "01035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.