Provider Demographics
NPI:1114075512
Name:BENNETT, ELLEN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S FESTIVAL DR
Mailing Address - Street 2:EL PASO
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5801
Mailing Address - Country:US
Mailing Address - Phone:915-845-8787
Mailing Address - Fax:915-821-5370
Practice Address - Street 1:109 S FESTIVAL DR
Practice Address - Street 2:EL PASO
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5801
Practice Address - Country:US
Practice Address - Phone:915-845-8787
Practice Address - Fax:915-821-5370
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528347OtherBCBS PROVIDER NO.
TX742832177OtherTAX IDENTIFICATION NUMBER