Provider Demographics
NPI:1093922312
Name:BENNETT, CRYSTAL BONURA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:BONURA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39641 RUE YVETTE
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6734
Mailing Address - Country:US
Mailing Address - Phone:985-370-1847
Mailing Address - Fax:
Practice Address - Street 1:8128 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7865
Practice Address - Country:US
Practice Address - Phone:225-791-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist