Provider Demographics
NPI:1225277320
Name:GREENSPAN, BONNIE SUSAN (MS,CCC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUSAN
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5605
Mailing Address - Country:US
Mailing Address - Phone:845-635-9278
Mailing Address - Fax:
Practice Address - Street 1:274 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-5605
Practice Address - Country:US
Practice Address - Phone:845-635-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006654-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist