Provider Demographics
NPI:1245596170
Name:RICE, BONNIE GLEE (MED)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:GLEE
Last Name:RICE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 STALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4335
Mailing Address - Country:US
Mailing Address - Phone:229-563-1580
Mailing Address - Fax:678-985-3953
Practice Address - Street 1:65 DARCEE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7402
Practice Address - Country:US
Practice Address - Phone:678-858-4777
Practice Address - Fax:678-985-3953
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist