Provider Demographics
NPI:1083468359
Name:AYOTTE, BONNIE LYNN (LH 60996772)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:AYOTTE
Suffix:
Gender:
Credentials:LH 60996772
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:ST GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5504 SKYVUE RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9538
Mailing Address - Country:US
Mailing Address - Phone:509-480-5634
Mailing Address - Fax:
Practice Address - Street 1:5504 SKYVUE RD
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9538
Practice Address - Country:US
Practice Address - Phone:509-480-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60996772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health