Clarence Leonard Bonander Jr.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

GL0087 Issued in MN

Practice address

817 Main St N
Cambridge, MN 55008-1275

Phone

(763) 325-0300

Fax

(763) 325-0301

NPI assigned

Aug 23, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spirited Psychological Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grantsburg, WI
  • NPI 1780234955
  NPD Authorized official
• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1881149433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-379-1704",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 MAIN ST N",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081275",
            "telephone_number": "763-325-0300",
            "fax_number": "763-325-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONANDER",
        "first_name": "CLARENCE",
        "middle_name": "LEONARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-23",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "GL0087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Anthony Blackburn, PH.D.
• Jacqueline Bleess, MS, MA, LPCC, LADC
• Jenny M Bliss, PMHNP
• Lacie Jesstine Blue-Nelson
• Juline Boege
• Cynthia Renee Bonde-Lorenzen, PT
• Deanna Bondhus
• Jodi Janice Barstow Boos-Blaszyk, PSYD
• Leigha Marie Bos, NP
• Carly Bourcy

• Clinical Psychologist in Cambridge, MN
• Providers in Cambridge, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.

Verify at the official NPI Registry.