Provider Demographics
NPI:1811044803
Name:BONNEY-LARAMORE, VANESSA (MHS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:BONNEY-LARAMORE
Suffix:
Gender:F
Credentials:MHS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 S FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3834
Mailing Address - Country:US
Mailing Address - Phone:773-737-1963
Mailing Address - Fax:773-737-1715
Practice Address - Street 1:8631 S FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3834
Practice Address - Country:US
Practice Address - Phone:773-737-1963
Practice Address - Fax:773-737-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636471OtherBLUE SHIELD PROVIDER NUMB
IL146002339OtherSTATE LICENSE
IL061768426OtherEIN