Provider Demographics
NPI:1902447345
Name:BONJOUR, NOELLE LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LYNN
Last Name:BONJOUR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 S REMINGTON PL STE 104
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5138
Mailing Address - Country:US
Mailing Address - Phone:605-553-1535
Mailing Address - Fax:605-338-3564
Practice Address - Street 1:6809 S MINNESOTA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2570
Practice Address - Country:US
Practice Address - Phone:605-553-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT10923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist