Provider Demographics
NPI:1902062334
Name:LEDESMA, BONNI M (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:M
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N 4TH ST
Mailing Address - Street 2:ARKANSAS CITY
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1607
Mailing Address - Country:US
Mailing Address - Phone:316-461-0496
Mailing Address - Fax:620-442-4089
Practice Address - Street 1:1711 N 4TH ST
Practice Address - Street 2:ARKANSAS CITY
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-1607
Practice Address - Country:US
Practice Address - Phone:316-461-0496
Practice Address - Fax:620-442-4089
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist