Basic Information
| Provider Information | |||||||||
| NPI: | 1306821129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETTS | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | PSYD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N STATE ST | ||||||||
| Address2: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560932811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078351210 | ||||||||
| FaxNumber: | 5078374280 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N STATE ST | ||||||||
| Address2: | WASECA MEDICAL CENTER - MAYO HEALTH SYSTEM | ||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560932811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5078351210 | ||||||||
| FaxNumber: | 5078374280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | LP0873 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 295J6BE | 01 | MN | BCBS | OTHER | 295J6BE | 01 | MN | MNCARE | OTHER | 323553000 | 05 | MN | MEDICAID | 114939 | 01 | MN | MNCARE-U | OTHER | HP28643 | 01 | MN | HEALTH PARTNERS | OTHER | NA9501007681 | 01 | MN | PREFERRED ONE | OTHER | P00054204 | 01 | MN | MEDICARE - RAILROAD | OTHER |