Provider Demographics
NPI:1558538843
Name:BONESS, TERESA (MS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:BONESS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-0707
Mailing Address - Country:US
Mailing Address - Phone:808-238-9565
Mailing Address - Fax:
Practice Address - Street 1:1107 E COBB AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2403
Practice Address - Country:US
Practice Address - Phone:808-238-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
HI1055235Z00000X
OK4504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist