Provider Demographics
NPI:1235447905
Name:SHLOUSH, BONNIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SHLOUSH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 27TH ST
Mailing Address - Street 2:APARTMENT 4H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9277
Mailing Address - Country:US
Mailing Address - Phone:212-545-1366
Mailing Address - Fax:
Practice Address - Street 1:240 E 27TH ST
Practice Address - Street 2:APARTMENT 4H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9277
Practice Address - Country:US
Practice Address - Phone:212-545-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013239-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist