Provider Demographics
NPI:1699194373
Name:BONFANTE, LAURA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BONFANTE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7702
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:
Practice Address - Street 1:3385 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE K
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7702
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-12-11388103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst