Provider Demographics
NPI:1548455249
Name:BOND, MARY BETH (SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:BOND
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 1:498 W MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2259
Mailing Address - Country:US
Mailing Address - Phone:770-597-4108
Mailing Address - Fax:
Practice Address - Street 1:1002 S DILLARD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-905-8908
Practice Address - Fax:407-905-8958
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist