Provider Demographics
NPI:1376102277
Name:SCOTT, BONNIE L (AUD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:MONTAGINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:872 MUNSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3638
Mailing Address - Country:US
Mailing Address - Phone:231-938-3111
Mailing Address - Fax:231-938-3214
Practice Address - Street 1:113 E LONG LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5500
Practice Address - Country:US
Practice Address - Phone:248-435-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000842231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist