Provider Demographics
NPI:1891446274
Name:BONNER, JERRI (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS,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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:LA
Mailing Address - Zip Code:71417-0208
Mailing Address - Country:US
Mailing Address - Phone:318-627-3274
Mailing Address - Fax:
Practice Address - Street 1:4528 HWY 500
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:LA
Practice Address - Zip Code:71432
Practice Address - Country:US
Practice Address - Phone:318-827-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist