Provider Demographics
NPI:1104983667
Name:BONIN, LAURA A (AUDIOLOGIST)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:BONIN
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4304
Mailing Address - Country:US
Mailing Address - Phone:316-267-5437
Mailing Address - Fax:316-267-5444
Practice Address - Street 1:340 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4304
Practice Address - Country:US
Practice Address - Phone:316-267-5437
Practice Address - Fax:316-267-5444
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1995231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist