Provider Demographics
NPI:1326206368
Name:SITMAN, BONNIE (SLP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SITMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MORDINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414
Mailing Address - Country:US
Mailing Address - Phone:304-725-9741
Mailing Address - Fax:
Practice Address - Street 1:110 MORDINGTON AVENUE
Practice Address - Street 2:JEFFERSON COUNTY BOARD OF EDUCATION
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-725-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003933Medicaid