Provider Demographics
NPI:1073813580
Name:BENNETT-SMITH, KERRY-ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY-ANN
Middle Name:
Last Name:BENNETT-SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3936
Mailing Address - Country:US
Mailing Address - Phone:917-604-2022
Mailing Address - Fax:516-665-8117
Practice Address - Street 1:711 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3936
Practice Address - Country:US
Practice Address - Phone:917-604-2022
Practice Address - Fax:516-665-8117
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019326-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist