Kelly M Bonnette, MA CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4044 Issued in MD

Practice address

29000 Information LN Ste 300
Easton, MD 21601-7038

Phone

(410) 822-2213

NPI assigned

Mar 23, 2007

Last updated

Sep 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1407973852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29000 INFORMATION LN STE 300",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29000 INFORMATION LN STE 300",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017038",
            "telephone_number": "410-822-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNETTE",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "MA CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "4044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@buildingbridgespeds.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "29000 Information Ln Ste 300",
            "city": "Easton",
            "state": "MD",
            "country_code": "US",
            "postal_code": "216017038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Easton, MD
• Providers in Easton, MD by specialty
• Speech-Language Pathologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.