Provider Demographics
NPI:1366439671
Name:WESTERGREEN, BONNIE S (M ED LMHC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:S
Last Name:WESTERGREEN
Suffix:
Gender:F
Credentials:M ED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-0496
Mailing Address - Country:US
Mailing Address - Phone:360-676-4803
Mailing Address - Fax:360-966-9996
Practice Address - Street 1:4200 MERIDIAN ST
Practice Address - Street 2:STE 212
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6462
Practice Address - Country:US
Practice Address - Phone:360-676-4803
Practice Address - Fax:360-966-9996
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health