Provider Demographics
NPI:1154885267
Name:BONNETTE, JULIA (MA-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BONNETTE
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S LAKE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3473
Mailing Address - Country:US
Mailing Address - Phone:803-356-4782
Mailing Address - Fax:803-996-4782
Practice Address - Street 1:714 S LAKE DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3473
Practice Address - Country:US
Practice Address - Phone:803-356-4782
Practice Address - Fax:803-996-4782
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7215235Z00000X
RBT-17-40999106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician