Active NPI
Jennifer Bonney, MACCC-SLP
- Speech-Language Pathologist
- Ft. Wayne, IN
National Provider Identifier
1003205154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22004261A
- Practice address
- 4180 Sage Bluff Crossing
Ft. Wayne, IN 46804 - Phone
- (260) 443-7300
- Fax
- (260) 482-5005
- NPI assigned
- Jan 13, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22004261A | IN | Primary |
Addresses
Primary practice location
4180 Sage Bluff Crossing
Ft. Wayne, IN 46804
Mailing address
4180 Sage Bluff Crossing
Ft. Wayne, IN 46804
Phone (260) 443-7300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22004261A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1003205154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4180 SAGE BLUFF CROSSING",
"city": "FT. WAYNE",
"state": "IN",
"postal_code": "46804",
"telephone_number": "260-443-7300",
"fax_number": "260-482-5005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4180 SAGE BLUFF CROSSING",
"city": "FT. WAYNE",
"state": "IN",
"postal_code": "46804",
"telephone_number": "260-443-7300",
"fax_number": "260-482-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNEY",
"first_name": "JENNIFER",
"credential": "MACCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22004261A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft. Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.