Most Relevant Information
Provider Data
| NPI Number: | 1003205154 |
| Provider Name: | JENNIFER BONNEY MACCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 22004261A |
Most Important Dates
| Enumeration Date: | 01/13/2015 |
| Last Updated: | 01/13/2015 |
Provider Practice Location
4180 SAGE BLUFF CROSSING
FT. WAYNE
IN
46804
Practice Location Phone/Fax
| Phone: | 2604437300 |
| Fax: | 2604825005 |
Provider Mailing Location
4180 SAGE BLUFF CROSSING
FT. WAYNE
IN
46804
Provider Mailing Phone/Fax
| Phone: | 2604437300 |
| Fax: | 2604825005 |