Provider Demographics
NPI:1881332906
Name:STONE, BONNIE SUE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2227
Mailing Address - Country:US
Mailing Address - Phone:918-775-5513
Mailing Address - Fax:
Practice Address - Street 1:1108 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2227
Practice Address - Country:US
Practice Address - Phone:918-755-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator