Provider Demographics
NPI:1477003580
Name:BONIFAS, PATRICIA (TRISH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA (TRISH)
Middle Name:
Last Name:BONIFAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3324
Mailing Address - Country:US
Mailing Address - Phone:402-463-5611
Mailing Address - Fax:
Practice Address - Street 1:824 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3324
Practice Address - Country:US
Practice Address - Phone:402-463-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist