Provider Demographics
NPI:1316181134
Name:BONELLI, PHYLLIS JOSEPHINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JOSEPHINE
Last Name:BONELLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:0100 LEFRAK HALL
Mailing Address - Street 2:DEPT OF HEARING & SPEECH SCIENCE UNIVERSITY OF MARYLAND
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742
Mailing Address - Country:US
Mailing Address - Phone:301-405-4237
Mailing Address - Fax:301-314-2023
Practice Address - Street 1:0100 LEFRAK HALL
Practice Address - Street 2:DEPT OF HEARING & SPEECH SCIENCE UNIVERSITY OF MARYLAND
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742
Practice Address - Country:US
Practice Address - Phone:301-405-4237
Practice Address - Fax:301-314-2023
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD03762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist