Provider Demographics
NPI:1467594325
Name:HEINTSKILL, BONNIE DEE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:DEE
Last Name:HEINTSKILL
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 1:307 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1429
Mailing Address - Country:US
Mailing Address - Phone:262-242-1642
Mailing Address - Fax:262-242-1642
Practice Address - Street 1:8949 N DEERBROOK TRL
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2431
Practice Address - Country:US
Practice Address - Phone:414-586-6280
Practice Address - Fax:414-365-3823
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1426-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42748900Medicaid