Provider Demographics
NPI:1952589582
Name:BONILLA, ELEONZETTA ENJOLI (MS, CCC-SLP/BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELEONZETTA
Middle Name:ENJOLI
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP/BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6302
Mailing Address - Country:US
Mailing Address - Phone:956-245-6050
Mailing Address - Fax:
Practice Address - Street 1:1510 S EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6302
Practice Address - Country:US
Practice Address - Phone:956-245-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3774103K00000X
OK1-20-46050103K00000X
FLSA16808235Z00000X
TX24779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202804501Medicaid