Provider Demographics
NPI:1922618461
Name:BERNERO, BONNIE ELISABETH (MS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELISABETH
Last Name:BERNERO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:ELISABETH
Other - Last Name:GRUBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:298 DORCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3429
Mailing Address - Country:US
Mailing Address - Phone:847-254-8932
Mailing Address - Fax:
Practice Address - Street 1:298 DORCHESTER LN
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3429
Practice Address - Country:US
Practice Address - Phone:847-254-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist