Provider Demographics
NPI:1497976336
Name:BONILLA, ROSEMARY (MS, CCC SLP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:COFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 CONNOLLY PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-230-2815
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-230-2815
Practice Address - Fax:203-230-8502
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003773OtherSTATE LICENSE