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NPI Code Detail

MEDICARE: EMMA BONNER

MEDICARE: EMMA BONNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianMI

General Provider Information

NPI Number : 1518817592
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA BONNER
Provider Business Mailing Address
First Line : 4435 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3810
Country : US
Telephone Number : 810-479-9375
Fax Number : 734-822-0237
Provider Business Practice Location Address
First Line : 4435 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3810
Country : US
Telephone Number : 810-479-9375
Fax Number : 734-822-0237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2026
Last Update Date : 01/30/2026

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Directions to “ EMMA BONNER ” Practice Location

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