Provider Demographics
NPI:1538538087
Name:HENRY, BONNIE (MA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 S SHARON AMITY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2866
Mailing Address - Country:US
Mailing Address - Phone:704-629-8463
Mailing Address - Fax:888-846-4064
Practice Address - Street 1:429 S SHARON AMITY RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2866
Practice Address - Country:US
Practice Address - Phone:704-629-8463
Practice Address - Fax:888-846-4064
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist