Individual
MIKAYLA BONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IECE
Contact information
Practice address
58 VAN BUREN AVE, WURTLAND, KY 41144-6238
(606) 694-2362
Mailing address
58 VAN BUREN AVE, WURTLAND, KY 41144-6238
(606) 694-2362
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
05/22/2023
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