Provider Demographics
NPI:1861914822
Name:ST. JOHN, BONITA SMITH (AUD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:SMITH
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 FONDERSMITH DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4812
Mailing Address - Country:US
Mailing Address - Phone:717-333-6931
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLANDS DR STE 307
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7692
Practice Address - Country:US
Practice Address - Phone:717-625-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000408L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist