Provider Demographics
NPI:1679729362
Name:COURVILLE, BONNIE D (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:D
Last Name:COURVILLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101A WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6613
Mailing Address - Country:US
Mailing Address - Phone:337-831-2518
Mailing Address - Fax:
Practice Address - Street 1:101A WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6613
Practice Address - Country:US
Practice Address - Phone:337-831-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist