Provider Demographics
NPI:1417245796
Name:SIU, BONNIE B (PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:SIU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN
Mailing Address - Street 2:101
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2990
Mailing Address - Country:US
Mailing Address - Phone:630-789-3110
Mailing Address - Fax:
Practice Address - Street 1:11 SALT CREEK LN
Practice Address - Street 2:101
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2990
Practice Address - Country:US
Practice Address - Phone:630-789-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000485231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist