Provider Demographics
NPI:1336283282
Name:VANDERWERFF, JENNIFER BONARO (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BONARO
Last Name:VANDERWERFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:BONARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 NW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2517
Mailing Address - Country:US
Mailing Address - Phone:206-228-2729
Mailing Address - Fax:206-691-8698
Practice Address - Street 1:222 NW 200TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2517
Practice Address - Country:US
Practice Address - Phone:206-228-2729
Practice Address - Fax:206-691-8698
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist