Provider Demographics
NPI:1114951274
Name:MELTZER, BONNIE GAIL (SLP, CCC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:GAIL
Last Name:MELTZER
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 COBBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7619
Mailing Address - Country:US
Mailing Address - Phone:847-564-4062
Mailing Address - Fax:847-564-4266
Practice Address - Street 1:2510 COBBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7619
Practice Address - Country:US
Practice Address - Phone:847-564-4062
Practice Address - Fax:847-564-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBM43941201P222Q00000X
IL146-001472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist