Provider Demographics
NPI:1518114552
Name:BONOMO, JULIE MARY (MS,SLP,CCC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARY
Last Name:BONOMO
Suffix:
Gender:F
Credentials:MS,SLP,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-0057
Mailing Address - Country:US
Mailing Address - Phone:409-256-5343
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-242-6500
Practice Address - Fax:409-497-4389
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX103159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No251E00000XAgenciesHome Health