Active NPI
Elise Bonilla, MS CCC-SLP
- Speech-Language Pathologist
- Austin, TX
National Provider Identifier
1871005173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 110673
- Practice address
- 1508 Southport Dr Apt 250
Austin, TX 78704-6806 - Phone
- (507) 828-2305
- NPI assigned
- Oct 27, 2017
- Last updated
- Jun 16, 2018
- 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 | 110673 | TX | Primary |
Addresses
Primary practice location
1508 Southport Dr Apt 250
Austin, TX 78704-6806
Mailing address
1508 Southport Dr Apt 250
Austin, TX 78704-6806
Phone (507) 828-2305
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Other | N/A |
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 |
|---|---|---|---|
| 110673 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1871005173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 SOUTHPORT DR APT 250",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787046806",
"telephone_number": "507-828-2305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1508 SOUTHPORT DR APT 250",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787046806",
"telephone_number": "507-828-2305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONILLA",
"first_name": "ELISE",
"credential": "MS CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-27",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "110673",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N/A",
"identifier": "00000000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.