Provider Demographics
NPI:1225396518
Name:SLAVYCH, BONNIE KATHERINE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:KATHERINE
Last Name:SLAVYCH
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 N NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4463
Mailing Address - Country:US
Mailing Address - Phone:501-412-5621
Mailing Address - Fax:
Practice Address - Street 1:3322 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4980
Practice Address - Country:US
Practice Address - Phone:888-672-3455
Practice Address - Fax:888-690-4153
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018015169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist