Provider Demographics
NPI:1407984644
Name:SIMON, BONNIE M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:M
Last Name:SIMON
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 1:402 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6743
Mailing Address - Country:US
Mailing Address - Phone:215-947-8978
Mailing Address - Fax:215-947-7043
Practice Address - Street 1:402 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6743
Practice Address - Country:US
Practice Address - Phone:215-947-8978
Practice Address - Fax:215-947-7043
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL 002673-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist