Provider Demographics
NPI:1588400519
Name:BONNAH, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BONNAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WILLIAM ST APT 127
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1090
Mailing Address - Country:US
Mailing Address - Phone:341-732-7991
Mailing Address - Fax:
Practice Address - Street 1:601 WILLIAM ST APT 127
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1090
Practice Address - Country:US
Practice Address - Phone:341-732-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician