Provider Demographics
NPI:1962529370
Name:BONATCH, JAMIE S
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:BONATCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 ANN CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-6007
Mailing Address - Country:US
Mailing Address - Phone:724-465-2931
Mailing Address - Fax:
Practice Address - Street 1:141 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2409
Practice Address - Country:US
Practice Address - Phone:724-548-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO3029237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist