Provider Demographics
NPI:1053560326
Name:BOHNTINSKY, DOROTHY FRASER (CCC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:FRASER
Last Name:BOHNTINSKY
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25890 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1410
Mailing Address - Country:US
Mailing Address - Phone:510-538-2747
Mailing Address - Fax:
Practice Address - Street 1:25890 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-1410
Practice Address - Country:US
Practice Address - Phone:510-538-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist