Provider Demographics
NPI:1427179100
Name:BONNER, MARY KAY (MM,MS,MT-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:BONNER
Suffix:
Gender:F
Credentials:MM,MS,MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 S 700 E
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9605
Mailing Address - Country:US
Mailing Address - Phone:317-769-3638
Mailing Address - Fax:
Practice Address - Street 1:2375 SOUTH, 700 EAST ROAD
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075
Practice Address - Country:US
Practice Address - Phone:317-760-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist