Individual
MS. JESSICA LORENA BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
156 LANDING MEADOW RD, SMITHTOWN, NY 11787-1100
(631) 626-6377
Mailing address
156 LANDING MEADOW RD, SMITHTOWN, NY 11787-1100
(631) 626-6377
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
—
—
235Z00000X
Speech-Language Pathologist
07643
MD
Other
Enumeration date
09/29/2014
Last updated
05/05/2021
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