Provider Demographics
NPI:1356594451
Name:GARCIA, JILL BONA (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:BONA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:BONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:18306 ARBOR CREST DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-0007
Mailing Address - Country:US
Mailing Address - Phone:727-657-7534
Mailing Address - Fax:
Practice Address - Street 1:11820 DENTON AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-862-9101
Practice Address - Fax:888-345-5315
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14355235Z00000X
FLSA-10493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist