Provider Demographics
NPI:1669461307
Name:BECK, BONNIE RAE (MSCCC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:RAE
Last Name:BECK
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NW 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-7817
Mailing Address - Country:US
Mailing Address - Phone:954-370-0778
Mailing Address - Fax:954-370-7956
Practice Address - Street 1:1111 NW 106TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-7817
Practice Address - Country:US
Practice Address - Phone:954-370-0778
Practice Address - Fax:954-370-7956
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA38235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880201701Medicaid
FL800201700Medicaid