Provider Demographics
NPI:1609244904
Name:CORK, BONNIE (AUD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CORK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 DRESSLER RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2784
Mailing Address - Country:US
Mailing Address - Phone:330-479-3333
Mailing Address - Fax:330-479-3334
Practice Address - Street 1:4048 DRESSLER RD NW STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-479-3333
Practice Address - Fax:330-479-3334
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01509231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist