Provider Demographics
NPI:1053373258
Name:BONEY, STEPHEN (PHD CCC-A)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BONEY
Suffix:
Gender:M
Credentials:PHD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 BARKLEY MEMORIAL CENTEER
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 BARKLEY MEMORIAL CENTEER
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0731
Practice Address - Country:US
Practice Address - Phone:402-472-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE93231H00000X
NE651237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE651OtherNE HEARING AID DISPENSER
NE93OtherNE AUDIOLOGY LICENSE
NEP00815213OtherRR MEDICARE PTAN
NE10025369400Medicaid
NE10025369300Medicaid
NE37021OtherBCBS
NE37021OtherBCBS
NE280156Medicare PIN