Provider Demographics
NPI:1669627378
Name:BONNER, ELIZABETH A (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:49 WIRELESS BLVD
Mailing Address - Street 2:STE 170
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3965
Mailing Address - Country:US
Mailing Address - Phone:631-382-7311
Mailing Address - Fax:631-382-7399
Practice Address - Street 1:49 WIRELESS BLVD
Practice Address - Street 2:STE 170
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3965
Practice Address - Country:US
Practice Address - Phone:631-382-7311
Practice Address - Fax:631-382-7399
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0179791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist