Healthcare Provider Details

I. General information

NPI: 1679062525
Provider Name (Legal Business Name): ALISON BONGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 WINTER GARDEN VINELAND RD STE 112
WINTER GARDEN FL
34787-4449
US

IV. Provider business mailing address

8356 IRON MOUNTAIN TRL
WINDERMERE FL
34786-9486
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-0029
  • Fax:
Mailing address:
  • Phone: 914-841-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: