Provider Demographics
NPI:1063599678
Name:BONNER, CHRIS W
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:W
Last Name:BONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CONSHOHOCKEN STATE RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1336
Mailing Address - Country:US
Mailing Address - Phone:610-896-6847
Mailing Address - Fax:
Practice Address - Street 1:1041 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4342
Practice Address - Country:US
Practice Address - Phone:610-933-8110
Practice Address - Fax:610-933-7451
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health