MEDICARE: MRS. BONNELYNN MARIE SWANSON 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	0044171	NY

General Provider Information

NPI Number	:	1679730634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNELYNN MARIE SWANSON CCC-SLP

Provider Business Mailing Address
First Line	:	104 WALDEMERE WAY
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750-1172
Country	:	US
Telephone Number	:	716-763-7729
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 WALDEMERE WAY
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750-1172
Country	:	US
Telephone Number	:	716-763-7729
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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