Active NPI
Mary Shannon Bonk, M.S. CCC-SLP
- Speech-Language Pathologist
- Leesburg, VA
National Provider Identifier
1114166386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202001042
- Practice address
- 43618 Carradoc Farm Ter
Leesburg, VA 20176-8232 - Phone
- (571) 333-3811
- Fax
- (571) 333-3811
- NPI assigned
- Feb 12, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 2202001042 | VA | Primary |
Addresses
Primary practice location
43618 Carradoc Farm Ter
Leesburg, VA 20176-8232
Mailing address
43618 Carradoc Farm Ter
Leesburg, VA 20176-8232
Phone (571) 333-3811
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2202001042 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236729600000",
"number": "1114166386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43618 CARRADOC FARM TER",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201768232",
"telephone_number": "571-333-3811",
"fax_number": "571-333-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43618 CARRADOC FARM TER",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201768232",
"telephone_number": "571-333-3811",
"fax_number": "571-333-3811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONK",
"first_name": "MARY",
"middle_name": "SHANNON",
"name_prefix": "Ms.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-12",
"last_updated": "2009-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202001042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.