Provider Demographics
NPI:1154605806
Name:BLAIR-SEIPLE, BONITA R (MA, CCC-SLP/L, TSHH)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:R
Last Name:BLAIR-SEIPLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1418
Mailing Address - Country:US
Mailing Address - Phone:585-307-7223
Mailing Address - Fax:
Practice Address - Street 1:13 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1526
Practice Address - Country:US
Practice Address - Phone:585-307-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist