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General NPI Number Information
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NPI Number | 1174403497
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Entity Type | Individual
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Provider Name | JESSICA BONNER
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Gender | Female
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 529 BEACON PKWY W STE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3126
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Country | US
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Telephone | 205-440-2294
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Fax | 205-850-5571
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Provider Business Mailing Address
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Address Line | 6209 WINDSOR LN
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City | PINSON
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State | AL
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Zip | 35126-3490
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Country | US
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Telephone | 205-440-2294
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Fax | 205-850-5571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4858
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License Number State | AL
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