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General NPI Number Information
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NPI Number | 1518114552
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Entity Type | Individual
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Provider Name | JULIE MARY BONOMO MS,SLP,CCC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 06/23/2018
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Provider Practice Location Address
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Address Line | 928 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550
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Country | US
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Telephone | 409-242-6500
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Fax | 409-497-4389
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | GALVESTON
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State | TX
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Zip | 77553-0057
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Country | US
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Telephone | 409-256-5343
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Fax |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 103159
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License Number State | TX
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