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General NPI Number Information
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NPI Number | 1154885267
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Entity Type | Individual
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Provider Name | JULIA BONNETTE MA-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 714 S LAKE DR STE 150
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City | LEXINGTON
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State | SC
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Zip | 29072-3473
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Country | US
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Telephone | 803-356-4782
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Fax | 803-996-4782
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Provider Business Mailing Address
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Address Line | 714 S LAKE DR STE 150
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City | LEXINGTON
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State | SC
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Zip | 29072-3473
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Country | US
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Telephone | 803-356-4782
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Fax | 803-996-4782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7215
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-40999
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License Number State |
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