Provider Demographics
NPI:1417103730
Name:BONT, LISA DANIELLE (MA,)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DANIELLE
Last Name:BONT
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32090 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1901
Mailing Address - Country:US
Mailing Address - Phone:586-725-5380
Mailing Address - Fax:586-725-6670
Practice Address - Street 1:32090 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1901
Practice Address - Country:US
Practice Address - Phone:586-725-5380
Practice Address - Fax:586-725-6670
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000490231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist