Provider Demographics
NPI:1053698670
Name:BONAGURA, CHRISTINE (MS, SLP/CCC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:BONAGURA
Suffix:
Gender:
Credentials:MS, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1933
Mailing Address - Country:US
Mailing Address - Phone:516-318-7324
Mailing Address - Fax:
Practice Address - Street 1:2860 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1125
Practice Address - Country:US
Practice Address - Phone:516-396-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY007591-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist