Provider Demographics
NPI:1508988916
Name:ADAMS, BONITA (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 BARONNE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1502
Mailing Address - Country:US
Mailing Address - Phone:919-539-6073
Mailing Address - Fax:877-791-3486
Practice Address - Street 1:2216 BARONNE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1502
Practice Address - Country:US
Practice Address - Phone:919-539-6073
Practice Address - Fax:704-749-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014494Medicaid