Provider Demographics
NPI:1588850937
Name:PODRAZA, BONNIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:PODRAZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SAVAGE RD
Mailing Address - Street 2:SUITE 400C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4704
Mailing Address - Country:US
Mailing Address - Phone:843-571-2700
Mailing Address - Fax:843-571-2124
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:SUITE 400C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4704
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:843-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist