Provider Demographics
NPI:1013140300
Name:BONENBERGER, PAMELA (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BONENBERGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:KADOKA
Mailing Address - State:SD
Mailing Address - Zip Code:57543-0483
Mailing Address - Country:US
Mailing Address - Phone:605-837-2731
Mailing Address - Fax:
Practice Address - Street 1:110 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:KADOKA
Practice Address - State:SD
Practice Address - Zip Code:57543
Practice Address - Country:US
Practice Address - Phone:605-837-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD028577-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist