Provider Demographics
NPI:1861647141
Name:EGAN, BONNIE S (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:S
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 96TH ST
Mailing Address - Street 2:APARTMENT 13E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0757
Mailing Address - Country:US
Mailing Address - Phone:212-427-0809
Mailing Address - Fax:
Practice Address - Street 1:60 E 96TH ST
Practice Address - Street 2:APARTMENT 13E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0757
Practice Address - Country:US
Practice Address - Phone:212-427-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist