Provider Demographics
NPI:1871868851
Name:BEAR, BONNIE LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYNN
Last Name:BEAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1345 WATERFORD GREEN CLOSE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2920
Mailing Address - Country:US
Mailing Address - Phone:770-639-8425
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5191
Practice Address - Country:US
Practice Address - Phone:770-433-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist