# BONNIE SLADE PH.D. P.A.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629480231
- **Authorized official:** DR. BONNIE SLADE PH.D. (PRESIDENT)
- **Authorized official phone:** (321) 729-0870

## Contact information

- **Practice address:** 1555 PORT MALABAR BLVD., SUITE 104, PALM BAY, FL 32958
- **Practice address phone:** (321) 729-0870
- **Practice address fax:** (321) 952-2516
- **Mailing address:** 1555 PORT MALABAR BLVD., SUITE 104, PALM BAY, FL 32958
- **Mailing address phone:** (321) 729-0870
- **Mailing address fax:** (321) 952-2516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PY002036 | FL | Yes |

## Other

- **Enumeration date:** 05/30/2014
- **Last updated:** 05/30/2014