Nelly Esther Bonilla Bonilla, PSYD, LP
Individual provider Active NPI Psychologist · Jordan, MN
NPI 1356830210 · NPPES record last updated Sep 19, 2024
Key facts
- NPI
- 1356830210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- LP6839 (PR)
- Practice address
- 863 Forest Edge Dr
Jordan, MN 55352-4502 - Phone
- (612) 475-0505
- NPI assigned
- May 7, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP6839 | PR | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Hope Psychology Center | Psychologist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP6839 | PR | Yes |
Addresses
Primary practice location
863 Forest Edge Dr
Jordan, MN 55352-4502
Mailing address
863 Forest Edge Dr
Jordan, MN 55352-4502
Phone (612) 475-0505
Other providers in Jordan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.