Provider Demographics
NPI:1831318377
Name:BONNO, RUTH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:BONNO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 W ADAM AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2437
Mailing Address - Country:US
Mailing Address - Phone:623-362-3414
Mailing Address - Fax:623-362-8329
Practice Address - Street 1:8914 W ADAM AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2437
Practice Address - Country:US
Practice Address - Phone:623-362-3414
Practice Address - Fax:623-362-8329
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341123OtherAHCCCS