Healthcare Provider Details

I. General information

NPI: 1083169593
Provider Name (Legal Business Name): BONNIE BYERS SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LINEBERRY BLVD
MOUNT JULIET TN
37122-5517
US

IV. Provider business mailing address

2004 SANFORD DR
MOUNT JULIET TN
37122-5401
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax: 615-758-6188
Mailing address:
  • Phone: 615-310-0529
  • Fax: 615-758-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: