Provider Demographics
NPI:1659501807
Name:BONNIE E. SMITH, PHD, LLC
Entity Type:Organization
Organization Name:BONNIE E. SMITH, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-769-1026
Mailing Address - Street 1:PO BOX 380513
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0513
Mailing Address - Country:US
Mailing Address - Phone:941-769-1026
Mailing Address - Fax:941-764-6869
Practice Address - Street 1:4122 LIBRARY ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2275
Practice Address - Country:US
Practice Address - Phone:941-769-1026
Practice Address - Fax:941-764-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty