Provider Demographics
NPI:1679009641
Name:BONNER, ANASTASIA (MS, LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS, LBA, BCBA
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:AVDEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 N WEBER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4720
Practice Address - Country:US
Practice Address - Phone:231-724-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician