Daniela Alejandra Bonilla Bermudez, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304119 Issued in MN

Practice address

6200 Excelsior Blvd Ste 203
St Louis Park, MN 55416-2734

Phone

(952) 548-9354

Fax

(952) 925-3264

NPI assigned

Apr 12, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1407210784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 EXCELSIOR BLVD STE 203",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162734",
            "telephone_number": "952-548-9354",
            "fax_number": "952-925-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 EXCELSIOR BLVD STE 203",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162734",
            "telephone_number": "952-548-9354",
            "fax_number": "952-925-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA BERMUDEZ",
        "first_name": "DANIELA",
        "middle_name": "ALEJANDRA",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie S Boman, MD
• Madilyn Bommersbach, PHARMD
• Megan Bona, PSYD
• Lisa Bonahoom, LMFT
• Jenna Bonde, RD, LD
• Karen Boortz, PSY.D. L.P.
• Kayla Kimberly Borchert, MA, CCC-SLP
• Bernard Borkon, D.D.S.
• Patrick Eugene Borowicz, RN
• Steven J Borowsky, M.D.

• Addiction (Substance Use Disorder) Counselor in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.