Provider Demographics
NPI:1548953185
Name:BONIFAY, ANNA KATHERINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHERINE
Last Name:BONIFAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MIAMOLA AVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-9243
Mailing Address - Country:US
Mailing Address - Phone:478-357-0049
Mailing Address - Fax:
Practice Address - Street 1:301 MIAMOLA AVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-9243
Practice Address - Country:US
Practice Address - Phone:478-357-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist