Healthcare Provider Details

I. General information

NPI: 1417324674
Provider Name (Legal Business Name): BONNIE MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 19TH ST
BROOKLYN NY
11215-6204
US

IV. Provider business mailing address

500 19TH ST
BROOKLYN NY
11215-6204
US

V. Phone/Fax

Practice location:
  • Phone: 718-498-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26998
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number029750
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: