MEDICARE: MRS. MARILYN V BONNETT MA CCCSLP

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	0079	WV

General Provider Information

NPI Number	:	1427121441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN V BONNETT MA CCCSLP

Provider Business Mailing Address
First Line	:	HC 80 BOX 6
Second Line	:
City	:	KENNA
State	:	WV
Zip	:	25248-9402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 MAPLE AVE
Second Line	:
City	:	FRANKLIN
State	:	WV
Zip	:	26807-0700
Country	:	US
Telephone Number	:	304-358-2325
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. MARILYN V BONNETT MA CCCSLP” Practice Location

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