Healthcare Provider Details

I. General information

NPI: 1659501807
Provider Name (Legal Business Name): BONNIE E. SMITH, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CITADEL DR
AIKEN SC
29803-6647
US

IV. Provider business mailing address

143 CITADEL DR
AIKEN SC
29803-6647
US

V. Phone/Fax

Practice location:
  • Phone: 941-769-1026
  • Fax: 803-845-5438
Mailing address:
  • Phone: 941-769-1026
  • Fax: 803-845-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 9201
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BONNIE E. SMITH
Title or Position: SOLE MEMBER/MANAGING MEMBER
Credential: PHD
Phone: 941-769-1026