1265653026 NPI number — MRS. BONNIE SARA FRIEDMAN M.A., CCC-SLP

Table of content: MRS. BONNIE SARA FRIEDMAN M.A., CCC-SLP (NPI 1265653026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265653026 NPI number — MRS. BONNIE SARA FRIEDMAN M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
BONNIE
Provider Middle Name:
SARA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIEDMAN
Provider Other First Name:
BAILA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265653026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6551 N MOZART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60645-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-381-5169
Provider Business Mailing Address Fax Number:
773-381-5169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6551 N MOZART ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60645-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-381-5169
Provider Business Practice Location Address Fax Number:
773-381-5169
Provider Enumeration Date:
05/01/2007

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: 235Z00000X , with the licence number:  146.007328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com