Provider Demographics
NPI:1477824993
Name:BONNETT, MARY M H (MSC-SLP, CCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M H
Last Name:BONNETT
Suffix:
Gender:F
Credentials:MSC-SLP, CCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 NEW KING ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1205
Mailing Address - Country:US
Mailing Address - Phone:914-390-9880
Mailing Address - Fax:914-390-9881
Practice Address - Street 1:6605 N QUAIL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1323
Practice Address - Country:US
Practice Address - Phone:901-758-0180
Practice Address - Fax:901-758-0180
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist