Provider Demographics
NPI:1588771943
Name:SINGLETARY, BONNIE JEAN (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:SINGLETARY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2859
Mailing Address - Country:US
Mailing Address - Phone:618-206-8365
Mailing Address - Fax:
Practice Address - Street 1:1018 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2859
Practice Address - Country:US
Practice Address - Phone:618-206-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist