Provider Demographics
NPI:1851717482
Name:BONSALL, MATTHEW R (AUD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:BONSALL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BERKSHIRE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1268
Mailing Address - Country:US
Mailing Address - Phone:610-374-5599
Mailing Address - Fax:610-375-1262
Practice Address - Street 1:985 BERKSHIRE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1268
Practice Address - Country:US
Practice Address - Phone:610-374-5599
Practice Address - Fax:610-375-1262
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006331231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029042340001Medicaid