Provider Demographics
NPI:1316459563
Name:AHN, BONNIE (PHD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-6722
Mailing Address - Country:US
Mailing Address - Phone:225-361-0507
Mailing Address - Fax:225-361-0363
Practice Address - Street 1:3973 CHOCTAW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-6722
Practice Address - Country:US
Practice Address - Phone:225-361-0507
Practice Address - Fax:225-361-0363
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA69041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical