Provider Demographics
NPI:1225846926
Name:BONNEY, JESSICA MAAME
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAAME
Last Name:BONNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 WILLAMETTE LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5694
Mailing Address - Country:US
Mailing Address - Phone:347-431-5569
Mailing Address - Fax:
Practice Address - Street 1:5104 WILLAMETTE LN
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5694
Practice Address - Country:US
Practice Address - Phone:347-431-5569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical