Provider Demographics
NPI:1568501831
Name:KELLY, BETHANY BONNANO (M A, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:BONNANO
Last Name:KELLY
Suffix:
Gender:F
Credentials:M A, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2805
Mailing Address - Country:US
Mailing Address - Phone:860-442-0407
Mailing Address - Fax:860-444-2015
Practice Address - Street 1:201 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2805
Practice Address - Country:US
Practice Address - Phone:860-442-0407
Practice Address - Fax:860-444-2015
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT442231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist