Provider Demographics
NPI:1891973723
Name:BONSER, REBECCA (MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BONSER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 SE 64TH PL
Mailing Address - Street 2:STE 2030
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5383
Mailing Address - Country:US
Mailing Address - Phone:425-358-0956
Mailing Address - Fax:877-481-6931
Practice Address - Street 1:21920 76TH AVE W
Practice Address - Street 2:STE 103
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-744-0891
Practice Address - Fax:425-775-4449
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004055237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0324420OtherWA L&I
WA2035504Medicaid
WA2035504Medicaid
WAG8927545Medicare PIN