Provider Demographics
NPI:1124212402
Name:WALLING, BONITA ELAINE (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:ELAINE
Last Name:WALLING
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9166
Mailing Address - Country:US
Mailing Address - Phone:724-834-2670
Mailing Address - Fax:724-834-2671
Practice Address - Street 1:711 ROUTE 119
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9166
Practice Address - Country:US
Practice Address - Phone:724-834-2670
Practice Address - Fax:724-834-2671
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist