Provider Demographics
NPI:1295074334
Name:BONACK, ZOE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ZOE
Middle Name:
Last Name:BONACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N UNION BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4083
Mailing Address - Country:US
Mailing Address - Phone:719-323-3094
Mailing Address - Fax:719-266-1773
Practice Address - Street 1:7680 GODDARD ST STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8233
Practice Address - Country:US
Practice Address - Phone:719-323-3094
Practice Address - Fax:719-266-1773
Is Sole Proprietor?:No
Enumeration Date:2013-02-09
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4301103TC1900X, 106H00000X, 103TC0700X, 103T00000X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist