Provider Demographics
NPI:1396073185
Name:HOAG, BONNIE LOUISE (MFT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOUISE
Last Name:HOAG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SIR FRANCIS DRAKE BLVD.
Mailing Address - Street 2:STE. F.
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-485-1177
Mailing Address - Fax:415-459-7420
Practice Address - Street 1:905 SIR FRANCIS DRAKE BLVD.
Practice Address - Street 2:STE. F.
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-485-1177
Practice Address - Fax:415-459-7420
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAME15908106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAME15908OtherMFT LICENSE BOARD OF BEHAVIORAL SCIENCE