Provider Demographics
NPI:1265688170
Name:FANELLI, BONNIE JO (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JO
Last Name:FANELLI
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 1:1938 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3353
Mailing Address - Country:US
Mailing Address - Phone:708-991-2742
Mailing Address - Fax:
Practice Address - Street 1:1938 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3353
Practice Address - Country:US
Practice Address - Phone:708-991-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist