Provider Demographics
NPI:1073714473
Name:HICKMAN-KAMARAD, BONITA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:HICKMAN-KAMARAD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46281 COMSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK
Mailing Address - State:NE
Mailing Address - Zip Code:68828-8015
Mailing Address - Country:US
Mailing Address - Phone:308-628-4247
Mailing Address - Fax:
Practice Address - Street 1:HC 68 BOX 561
Practice Address - Street 2:
Practice Address - City:COMSTOCK
Practice Address - State:NE
Practice Address - Zip Code:68828-9630
Practice Address - Country:US
Practice Address - Phone:308-628-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE951181OtherNDE SERVICE PROVIDER