Provider Demographics
NPI:1265275077
Name:BONNIWELL, SYLVIA C (CLC)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:C
Last Name:BONNIWELL
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:MS
Other - First Name:SYLVIA
Other - Middle Name:C
Other - Last Name:BONNIWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:1801 RUFE SNOW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5712
Mailing Address - Country:US
Mailing Address - Phone:817-393-7020
Mailing Address - Fax:855-512-3801
Practice Address - Street 1:1801 RUFE SNOW DR STE 200
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5712
Practice Address - Country:US
Practice Address - Phone:817-393-7020
Practice Address - Fax:855-512-3801
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXALPP-353696174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN