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NPI Code Detail

MEDICARE: ANASTASIA BONNER MS, LBA, BCBA

MEDICARE: ANASTASIA BONNER MS, LBA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior AnalystMI

General Provider Information

NPI Number : 1679009641
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANASTASIA BONNER MS, LBA, BCBA
Provider Business Mailing Address
First Line : 115 N WEBER RD
Second Line :
City : MUSKEGON
State : MI
Zip : 49445-2155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 640 SEMINOLE RD
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4720
Country : US
Telephone Number : 231-724-1152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 07/30/2021

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