Provider Demographics
NPI:1639600828
Name:RAVO, BONNIE SALETT (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SALETT
Last Name:RAVO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 COVIL AVE
Mailing Address - Street 2:#100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2684
Mailing Address - Country:US
Mailing Address - Phone:401-261-7750
Mailing Address - Fax:
Practice Address - Street 1:503 COVIL AVE
Practice Address - Street 2:#100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2684
Practice Address - Country:US
Practice Address - Phone:401-261-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist