Provider Demographics
NPI:1194880542
Name:BONJEAN, RONALD DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:BONJEAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N DOWNER AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2466
Mailing Address - Country:US
Mailing Address - Phone:414-964-7493
Mailing Address - Fax:
Practice Address - Street 1:1524 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2329
Practice Address - Country:US
Practice Address - Phone:414-273-2220
Practice Address - Fax:414-273-2223
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI604-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health