Healthcare Provider Details

I. General information

NPI: 1093723116
Provider Name (Legal Business Name): LISA BONO DUNWOODY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14031 SOUTHWEST FWY SUITE 610
SUGAR LAND TX
77478-3575
US

IV. Provider business mailing address

14031 SOUTHWEST FWY SUITE 610
SUGAR LAND TX
77478-3575
US

V. Phone/Fax

Practice location:
  • Phone: 281-494-0606
  • Fax:
Mailing address:
  • Phone: 281-494-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19041
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: