Provider Demographics
NPI:1275424251
Name:PECKFELDER, BONNIE JO
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:PECKFELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JO
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3221 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1545
Mailing Address - Country:US
Mailing Address - Phone:541-401-7087
Mailing Address - Fax:
Practice Address - Street 1:3221 S MAIN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-1545
Practice Address - Country:US
Practice Address - Phone:541-401-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR114353374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula