Provider Demographics
NPI:1609841600
Name:WHIPPLE, BONNIE L (PHD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:WHIPPLE
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 1:10 BURGESS AVE
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9403
Mailing Address - Country:US
Mailing Address - Phone:570-374-0496
Mailing Address - Fax:
Practice Address - Street 1:905 US RTE 522
Practice Address - Street 2:EVANGELICAL MEDICAL BUILDING
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870
Practice Address - Country:US
Practice Address - Phone:570-374-0496
Practice Address - Fax:570-374-3295
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006902L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018933940003Medicaid
PA50009445OtherCAPITAL BLUE CROSS
PA001411997OtherHIGHMARK BC/BS
PA0018933940003Medicaid