Provider Demographics
NPI:1023458247
Name:STEWART-HENSON, BONNIE (SLP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:STEWART-HENSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CHAUNCEY ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2412
Mailing Address - Country:US
Mailing Address - Phone:610-999-8081
Mailing Address - Fax:
Practice Address - Street 1:340 CHAUNCEY ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2412
Practice Address - Country:US
Practice Address - Phone:610-999-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist