Individual
BONNIE L VAILLANCOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
148 KEY ROAD SUITE B, KEENE, NH 03431-3927
(603) 352-4199
(603) 352-9177
Mailing address
148 KEY ROAD SUITE B, KEENE, NH 03431-3927
(603) 352-4199
(603) 352-9177
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1002
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3072519
—
NH
01
—
66Y011060NH01
ANTHEM
NH
Enumeration date
05/10/2007
Last updated
09/11/2020
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