Provider Demographics
NPI:1619125945
Name:BONVELL, JENNA MAHAR (MA,CCC- SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MAHAR
Last Name:BONVELL
Suffix:
Gender:F
Credentials:MA,CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MAPLE VALLEY CRES
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5209
Mailing Address - Country:US
Mailing Address - Phone:585-764-5578
Mailing Address - Fax:
Practice Address - Street 1:143 N PEARL ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1430
Practice Address - Country:US
Practice Address - Phone:585-764-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist