Provider Demographics
NPI:1396076113
Name:BONKOFSKY, ASHLEY G
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:G
Last Name:BONKOFSKY
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 1:4317 W 625 S
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6800
Mailing Address - Country:US
Mailing Address - Phone:501-743-8497
Mailing Address - Fax:844-854-4658
Practice Address - Street 1:471 HERITAGE PARK BLVD
Practice Address - Street 2:#5
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5712
Practice Address - Country:US
Practice Address - Phone:501-743-8497
Practice Address - Fax:844-854-4658
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8951152-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-1095368OtherEIN