MEDICARE: KATRINA BONUS

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		NJ

General Provider Information

NPI Number	:	1619807898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA BONUS

Provider Business Mailing Address
First Line	:	30 E BRADFORD AVE
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1942
Country	:	US
Telephone Number	:	973-234-4167
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 WATCHUNG PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-4117
Country	:	US
Telephone Number	:	973-744-0804
Fax Number	:	973-509-8509

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ KATRINA BONUS ” Practice Location

Language	Start Address	Practice Location

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