Individual
JACKIE BUNGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA/CCC-SLP
Contact information
Practice address
3590 STATE ROUTE 59, RAVENNA, OH 44266-1380
(330) 297-6708
Mailing address
3590 STATE ROUTE 59, RAVENNA, OH 44266-1380
(330) 297-6708
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP6345
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12033476
ASHA
—
01
—
SP6345
OHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
—
Enumeration date
09/08/2014
Last updated
09/08/2014
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