Provider Demographics
NPI:1285667998
Name:BONKO, JULIE A (CCC-A)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BONKO
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2269
Mailing Address - Country:US
Mailing Address - Phone:419-520-2064
Mailing Address - Fax:419-520-2061
Practice Address - Street 1:335 GLESSNER AVE
Practice Address - Street 2:OHIOHEALTH AUDIOLOGY
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2269
Practice Address - Country:US
Practice Address - Phone:419-520-2064
Practice Address - Fax:419-520-2061
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00704231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652366Medicaid
OH2652366Medicaid