Provider Demographics
NPI:1215595855
Name:BONNETTE, HALEY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BONNETTE
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 1:12413 CAMP CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-4293
Mailing Address - Country:US
Mailing Address - Phone:318-514-8771
Mailing Address - Fax:
Practice Address - Street 1:12413 CAMP CIRCLE RD
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-4293
Practice Address - Country:US
Practice Address - Phone:318-514-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist