Provider Demographics
NPI:1578736401
Name:CHESTER, BONNIE K (MA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:K
Last Name:CHESTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:S
Other - Last Name:KIMBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:6817 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3958
Mailing Address - Country:US
Mailing Address - Phone:608-298-9475
Mailing Address - Fax:
Practice Address - Street 1:6817 PUTNAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-3958
Practice Address - Country:US
Practice Address - Phone:608-298-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2162-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42788300Medicaid