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Individual

MS. JENNIFER CANDACE BONNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
9548B MAIN ST, FAIRFAX, VA 22031-4031
(571) 746-9614
Mailing address
1925 ROLAND CLARKE PL APT 109, RESTON, VA 20191-1453
(843) 566-2570

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201002074
VA
231H00000X
Audiologist
3922
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3922
SC STATE LICENSE
SC
Enumeration date
03/03/2010
Last updated
01/20/2026
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