Provider Demographics
NPI:1669981262
Name:JULIE M BONOMO
Entity type:Organization
Organization Name:JULIE M BONOMO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:409-242-6500
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0057
Mailing Address - Country:US
Mailing Address - Phone:409-242-6500
Mailing Address - Fax:409-497-4389
Practice Address - Street 1:928 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-6228
Practice Address - Country:US
Practice Address - Phone:409-242-6500
Practice Address - Fax:409-497-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty