Organization
BONNIE SLADE PH.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONNIE SLADE PH.D. (PRESIDENT)
(321) 729-0870
Entity
Organization
Contact information
Practice address
1555 PORT MALABAR BLVD., SUITE 104, PALM BAY, FL 32958
(321) 729-0870
(321) 952-2516
Mailing address
1555 PORT MALABAR BLVD., SUITE 104, PALM BAY, FL 32958
(321) 729-0870
(321) 952-2516
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PY002036
FL
Other
Enumeration date
05/30/2014
Last updated
05/30/2014
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