Provider Demographics
NPI:1043564842
Name:SINS, BONNIE T
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:T
Last Name:SINS
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 1:6018 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:KILN
Mailing Address - State:MS
Mailing Address - Zip Code:39556-8138
Mailing Address - Country:US
Mailing Address - Phone:228-255-3761
Mailing Address - Fax:
Practice Address - Street 1:6018 PONTIAC DR
Practice Address - Street 2:
Practice Address - City:KILN
Practice Address - State:MS
Practice Address - Zip Code:39556-8138
Practice Address - Country:US
Practice Address - Phone:228-255-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist