Provider Demographics
NPI:1740889807
Name:DAVIS, BONNIE ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:DAVIS
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 1:2024 ROSECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1240
Mailing Address - Country:US
Mailing Address - Phone:731-607-7562
Mailing Address - Fax:
Practice Address - Street 1:2000 HAYES ST STE 1502
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2645
Practice Address - Country:US
Practice Address - Phone:615-284-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty