1467586164 NPI number — BONNIE M. VEST MA CCC-SLP

Table of content: BONNIE M. VEST MA CCC-SLP (NPI 1467586164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467586164 NPI number — BONNIE M. VEST MA CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEST
Provider First Name:
BONNIE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467586164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2206 N JACKSON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGNOLIA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71753-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-510-2841
Provider Business Mailing Address Fax Number:
844-315-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2206 N JACKSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGNOLIA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71753-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-510-2841
Provider Business Practice Location Address Fax Number:
844-315-7385
Provider Enumeration Date:
03/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP#1725 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12024497 . This is a "ASHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139686721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5X283 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 105435 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1725 . This is a "STATE LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".