Mary Shannon Bonk, M.S. CCC-SLP
Speech-Language Pathologist, in Leesburg, VA. Individual provider (NPI-1).
NPI number1114166386
StatusActive
Last updated in NPPESMar 11, 2009
Details
- NPI
- 1114166386
- Entity type
- Individual (NPI-1)
- Name
- Ms. Mary Shannon Bonk
- Credential
- M.S. CCC-SLP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 12, 2009
- Last updated
- Mar 11, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 2202001042 | VA | Yes |
Practice location
43618 Carradoc Farm TerLeesburg, VA 20176-8232
Phone 571-333-3811 · Fax 571-333-3811
Mailing address
43618 Carradoc Farm TerLeesburg, VA 20176-8232
Phone 571-333-3811 · Fax 571-333-3811
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 52 Speech-Language Pathologist providers in Leesburg · All 2,386 providers in Leesburg
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