Individual
JENNIFER WIEMANN BONVILLAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
109 WELLINGTON DR, HOUMA, LA 70360-7277
(985) 226-0209
Mailing address
109 WELLINGTON DR, HOUMA, LA 70360-7277
(985) 226-0209
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3854
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1302651
—
LA
Enumeration date
03/07/2007
Last updated
07/08/2007
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