MEDICARE: LAURA BONFANTE MS, 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
1	103K00000X	Behavior Analyst	1-12-11388	IL

General Provider Information

NPI Number	:	1699194373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BONFANTE MS, BCBA

Provider Business Mailing Address
First Line	:	3385 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE K
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7702
Country	:	US
Telephone Number	:	844-247-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3385 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE K
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7702
Country	:	US
Telephone Number	:	844-247-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	03/06/2017

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