Provider Demographics
NPI:1851795173
Name:BONNEVAL, AIMEE
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:BONNEVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SE MILL ST STE 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5096
Mailing Address - Country:US
Mailing Address - Phone:504-261-1270
Mailing Address - Fax:
Practice Address - Street 1:350 SE MILL ST STE 12
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5096
Practice Address - Country:US
Practice Address - Phone:971-220-2759
Practice Address - Fax:503-954-2250
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2050175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath