Provider Demographics
NPI:1477367845
Name:BONACCI, NICOLETTA MARIE
Entity type:Individual
Prefix:
First Name:NICOLETTA
Middle Name:MARIE
Last Name:BONACCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 DREIBELBIS ST APT 433
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7576
Mailing Address - Country:US
Mailing Address - Phone:412-709-9332
Mailing Address - Fax:
Practice Address - Street 1:3333 BEALE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1549
Practice Address - Country:US
Practice Address - Phone:814-944-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL002750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist