MEDICARE: RACHEL BONILLA MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	17545	OR

General Provider Information

NPI Number	:	1699630764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BONILLA MS, CCC-SLP

Provider Business Mailing Address
First Line	:	11195 SW FONNER ST
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-3916
Country	:	US
Telephone Number	:	503-889-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	21800 SW 91ST AVE # 929
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-9296
Country	:	US
Telephone Number	:	503-431-4276
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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Directions to “ RACHEL BONILLA MS, CCC-SLP” Practice Location

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