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General NPI Number Information
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NPI Number | 1780336677
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Entity Type | Individual
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Provider Name | MRS. MILDRET H BONILLA
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 2941 MOLLIMAR DR
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City | PLANO
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State | TX
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Zip | 75075-6319
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Country | US
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Telephone | 469-752-3635
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 CLADDING DR
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City | PLANO
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State | TX
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Zip | 75075-0005
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Country | US
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Telephone | 214-435-8350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 100613
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License Number State | TX
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