Doctor Name: | JENNIFER BONNEY |
NPI Number: | 1003205154 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCC-SLP |
License Number: | 22004261A |
Business Practice Address: | 4180 Sage Bluff Crossing Ft. Wayne, IN - 46804 |
Business Phone Number: | 2604437300 |
Business Fax Number: | 2604825005 |
Mailing Address: | 4180 Sage Bluff Crossing, FT. WAYNE |
State: | IN |
Postal Code: | 46804 |
Phone Number: | 2604437300 |
Fax Number: | 2604825005 |
NPI Enumeration Date: | 01/13/2015 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22004261A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |