Individual
MRS. BONNIE RAE BECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.CCC
Contact information
Practice address
1111 NW 106TH AVE, PLANTATION, FL 33322-7817
(954) 370-0778
(954) 370-7956
Mailing address
1111 NW 106TH AVE, PLANTATION, FL 33322-7817
(954) 370-0778
(954) 370-7956
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA38
FL
252Y00000X
Early Intervention Provider Agency
SA38
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800201700
—
FL
05
—
880201701
—
FL
Enumeration date
10/16/2005
Last updated
06/21/2011
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