Provider Demographics
NPI:1821117417
Name:WARNER, BONNIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WARNER
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 1:119 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3372
Mailing Address - Country:US
Mailing Address - Phone:781-910-9342
Mailing Address - Fax:
Practice Address - Street 1:841 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3500
Practice Address - Country:US
Practice Address - Phone:978-459-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3657235Z00000X
NH1003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist