Healthcare Provider Details

I. General information

NPI: 1386875367
Provider Name (Legal Business Name): BONNIE WALDMAN & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 RODNEY DR SUITE 204
LOS ANGELES CA
90027-2674
US

IV. Provider business mailing address

2055 RODNEY DR SUITE 204
LOS ANGELES CA
90027-2674
US

V. Phone/Fax

Practice location:
  • Phone: 323-664-2399
  • Fax:
Mailing address:
  • Phone: 323-664-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number591
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12872
License Number StateCA

VIII. Authorized Official

Name: BONNIE WALDMAN
Title or Position: OWNER
Credential: MA, CCC-SLP
Phone: 323-664-2399