Provider Demographics
NPI:1407122757
Name:CRANDELL, BONNIE J (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:J
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HEWITT RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9407
Mailing Address - Country:US
Mailing Address - Phone:864-962-0120
Mailing Address - Fax:
Practice Address - Street 1:118 HEWITT RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-9407
Practice Address - Country:US
Practice Address - Phone:864-962-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist