Provider Demographics
NPI:1952592925
Name:BONOMI, VALERIE JEAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JEAN
Last Name:BONOMI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:JEAN
Other - Last Name:DEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3908 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5146
Mailing Address - Country:US
Mailing Address - Phone:509-430-5872
Mailing Address - Fax:888-948-5923
Practice Address - Street 1:3908 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5146
Practice Address - Country:US
Practice Address - Phone:509-430-5872
Practice Address - Fax:888-948-5923
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021133225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist