1801171376 NPI number — BONNIE GRACE STANLEY M.ED.,ED.S.

Table of content: BONNIE GRACE STANLEY M.ED.,ED.S. (NPI 1801171376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801171376 NPI number — BONNIE GRACE STANLEY M.ED.,ED.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANLEY
Provider First Name:
BONNIE
Provider Middle Name:
GRACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED.,ED.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALONE
Provider Other First Name:
BONNIE
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801171376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1134 W WINGED FOOT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-365-8994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 N ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE200
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-4367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  SS996 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SS996 . This is a "LICENSED SCHOOL PSYCHOLOGIST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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