Provider Demographics
NPI:1104958925
Name:ROBERSON, BONNIE L (MSC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 WALNUT HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2745
Mailing Address - Country:US
Mailing Address - Phone:916-966-7261
Mailing Address - Fax:
Practice Address - Street 1:2330 GLENDALE LN
Practice Address - Street 2:STE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2454
Practice Address - Country:US
Practice Address - Phone:916-641-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor