MEDICARE: MS. JENNIFER ALYSSA BONELLI M.S., CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	017567	NY

General Provider Information

NPI Number	:	1982077830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ALYSSA BONELLI M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1935 80TH ST
Second Line	:	#1C
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1318
Country	:	US
Telephone Number	:	917-828-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 80TH ST
Second Line	:	#1C
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1318
Country	:	US
Telephone Number	:	917-828-7284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2015
Last Update Date	:	11/01/2015

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Directions to “ MS. JENNIFER ALYSSA BONELLI M.S., CCC-SLP” Practice Location

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