Provider Demographics
NPI:1467586164
Name:VEST, BONNIE M (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:VEST
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 1:2206 N JACKSON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2065
Mailing Address - Country:US
Mailing Address - Phone:870-510-2841
Mailing Address - Fax:844-315-7385
Practice Address - Street 1:2206 N JACKSON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2065
Practice Address - Country:US
Practice Address - Phone:870-510-2841
Practice Address - Fax:844-315-7385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12024497OtherASHA
AR139686721Medicaid
AR5X283OtherBCBS
TX105435OtherSTATE LICENSE
AR1725OtherSTATE LICENSE