Provider Demographics
NPI:1508054743
Name:BONNEY, MIRANDA MICHELLE (SLP)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:MICHELLE
Last Name:BONNEY
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 1:1453 SW MANOR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4182
Mailing Address - Country:US
Mailing Address - Phone:660-232-2298
Mailing Address - Fax:
Practice Address - Street 1:129 NE PARKS VIEW CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2353
Practice Address - Country:US
Practice Address - Phone:816-588-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist