Individual
BONNIE L BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-5377
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-5377
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2922-154
WI
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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