MEDICARE: MRS. BONNIE M SIMON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL 002673-L	PA

General Provider Information

NPI Number	:	1407984644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE M SIMON CCC-SLP

Provider Business Mailing Address
First Line	:	402 PEPPER RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6743
Country	:	US
Telephone Number	:	215-947-8978
Fax Number	:	215-947-7043

Provider Business Practice Location Address
First Line	:	402 PEPPER RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6743
Country	:	US
Telephone Number	:	215-947-8978
Fax Number	:	215-947-7043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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