Provider Demographics
NPI:1346299823
Name:MCINTOSH, BONNIE J (PHD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:MCINTOSH
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 1:1104 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5441
Mailing Address - Country:US
Mailing Address - Phone:206-830-0761
Mailing Address - Fax:425-889-8362
Practice Address - Street 1:1104 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5441
Practice Address - Country:US
Practice Address - Phone:206-830-0761
Practice Address - Fax:425-889-8362
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist