Provider Demographics
NPI:1083169593
Name:BYERS, BONNIE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BYERS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 SANFORD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5401
Mailing Address - Country:US
Mailing Address - Phone:615-310-0529
Mailing Address - Fax:615-758-6188
Practice Address - Street 1:116 LINEBERRY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5517
Practice Address - Country:US
Practice Address - Phone:615-758-4888
Practice Address - Fax:615-758-6188
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist