Provider Demographics
NPI:1588137988
Name:BUNTON, NATALIE K (CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:K
Last Name:BUNTON
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24829 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5294
Mailing Address - Country:US
Mailing Address - Phone:815-931-5977
Mailing Address - Fax:
Practice Address - Street 1:24829 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5294
Practice Address - Country:US
Practice Address - Phone:815-931-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist