Provider Demographics
NPI:1912767591
Name:BONNIE KNOWS BREAST, LLC
Entity Type:Organization
Organization Name:BONNIE KNOWS BREAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:LOGSDON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, IBCLC
Authorized Official - Phone:270-202-9545
Mailing Address - Street 1:1341 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2303
Mailing Address - Country:US
Mailing Address - Phone:270-202-9545
Mailing Address - Fax:
Practice Address - Street 1:6500 GLENRIDGE PARK PL STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3450
Practice Address - Country:US
Practice Address - Phone:270-202-9545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty