Provider Demographics
NPI:1730578147
Name:BONK, EMILY ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:BONK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 RICK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2951
Mailing Address - Country:US
Mailing Address - Phone:586-566-0326
Mailing Address - Fax:
Practice Address - Street 1:14153 RICK DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2951
Practice Address - Country:US
Practice Address - Phone:586-566-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4066-154235Z00000X
MI7101005707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist