Provider Demographics
NPI:1245739192
Name:BONNER, ROBIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:FOLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 KIRKWALL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-2912
Mailing Address - Country:US
Mailing Address - Phone:609-221-4179
Mailing Address - Fax:
Practice Address - Street 1:137 EGG HARBOR RD STE H
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9404
Practice Address - Country:US
Practice Address - Phone:856-432-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00933500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist