Provider Demographics
NPI:1205175783
Name:BONNER, HALEY (MS, CFY-SLP)
Entity type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS, CFY-SLP
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 435
Mailing Address - Street 2:
Mailing Address - City:GONZALEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560-0435
Mailing Address - Country:US
Mailing Address - Phone:850-516-7783
Mailing Address - Fax:
Practice Address - Street 1:1148 SWEETBRIAR ST
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-2919
Practice Address - Country:US
Practice Address - Phone:850-516-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5805390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program