Healthcare Provider Details

I. General information

NPI: 1699630764
Provider Name (Legal Business Name): RACHEL BONILLA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21800 SW 91ST AVE # 929
TUALATIN OR
97062-9296
US

IV. Provider business mailing address

11195 SW FONNER ST
TIGARD OR
97223-3916
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-4276
  • Fax:
Mailing address:
  • Phone: 503-889-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17545
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: