Basic Information
| Provider Information | |||||||||
| NPI: | 1104281708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | BETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 BALLENGER CENTER DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217037095 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2177 SWAINS LOCK CT | ||||||||
| Address2: | |||||||||
| City: | POINT OF ROCKS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217772014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016635181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2015 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 05447 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.