NPI Code Detail JSON Logo

1629536289 NPI number — MARY RUTH BONNER CCC SLP

NPI Number: 1629536289
Health Care Provider/Practitioner: MARY RUTH BONNER CCC SLP

Information about “1629536289” NPI (MARY RUTH BONNER CCC SLP) exists in 1629536289 in HTML format HTML  |  1629536289 in plain Text format TXT  |  1629536289 in PDF (Portable Document Format) PDF  |  1629536289 in an XML format XML  formats.

NPI Number : 1629536289 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629536289",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BONNER",
    "FirstName": "MARY",
    "MiddleName": "RUTH",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CCC SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "O'MALLEY",
    "OtherFirstName": "MARY",
    "OtherMiddleName": "RUTH",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "CCC SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3056 LINDSAY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT HURON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48060-7777",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "810-434-2105",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3056 LINDSAY LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT HURON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48060-7777",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "810-434-2105",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/03/2019",
    "LastUpdateDate": "03/03/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "7101001523",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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