Provider Demographics
NPI:1740621531
Name:MAI, BONNA JILL (SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNA
Middle Name:JILL
Last Name:MAI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E HARFORD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1002
Mailing Address - Country:US
Mailing Address - Phone:570-296-5156
Mailing Address - Fax:
Practice Address - Street 1:112 E HARFORD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1002
Practice Address - Country:US
Practice Address - Phone:570-296-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist