Provider Demographics
NPI:1407734817
Name:NELSON-GROSS, BONNIE JEAN
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:NELSON-GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JEAN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1613 ETHAN DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1275
Mailing Address - Country:US
Mailing Address - Phone:610-301-5859
Mailing Address - Fax:
Practice Address - Street 1:200 SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19610-3334
Practice Address - Country:US
Practice Address - Phone:610-927-6593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health