Doctor Name: | MRS. BONNIE LOU BLACK |
NPI Number: | 1285780254 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 630 |
Business Practice Address: | 2400 47th Ave S Grand Forks, ND - 582013405 |
Business Phone Number: | 7017462230 |
Business Fax Number: | |
Mailing Address: | 1102 S 36th St, GRAND FORKS |
State: | ND |
Postal Code: | 582013904 |
Phone Number: | 7017952155 |
Fax Number: | |
NPI Enumeration Date: | 01/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 630 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |