Provider Demographics
NPI:1740634856
Name:BONNY, KATHY (LHAS, AA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BONNY
Suffix:
Gender:F
Credentials:LHAS, AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9858 GLADES RD
Mailing Address - Street 2:STE D2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3983
Mailing Address - Country:US
Mailing Address - Phone:561-451-3626
Mailing Address - Fax:561-451-0569
Practice Address - Street 1:9858 GLADES RD
Practice Address - Street 2:STE D2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3983
Practice Address - Country:US
Practice Address - Phone:561-451-3626
Practice Address - Fax:561-451-0569
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5177237700000X
FLAI2312355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant