Provider Demographics
NPI:1841943958
Name:BONHAM, KELCY (MS, CCC- SLP, CLC)
Entity type:Individual
Prefix:
First Name:KELCY
Middle Name:
Last Name:BONHAM
Suffix:
Gender:F
Credentials:MS, CCC- SLP, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BROOKVALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-9213
Mailing Address - Country:US
Mailing Address - Phone:615-477-6363
Mailing Address - Fax:
Practice Address - Street 1:1530 BROOKVALLEY CIR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-9213
Practice Address - Country:US
Practice Address - Phone:615-477-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14170424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist