MEDICARE: MS. JEAN ANNE BOND

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	1084	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00639393	OTHER	NE	ASHA CERTIFICATION

General Provider Information

NPI Number	:	1477898450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN ANNE BOND

Provider Business Mailing Address
First Line	:	3223 N 157TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2070
Country	:	US
Telephone Number	:	402-572-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 N 157TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2070
Country	:	US
Telephone Number	:	402-572-8966
Fax Number	:

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

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/03/2012

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Directions to “ MS. JEAN ANNE BOND ” Practice Location

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