Provider Demographics
NPI:1114213592
Name:BENNETT, LISA A (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BENNETT
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 1:1500 E TALL TREE RD
Mailing Address - Street 2:#38202
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2099
Mailing Address - Country:US
Mailing Address - Phone:316-308-5428
Mailing Address - Fax:
Practice Address - Street 1:10000 W 75TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2209
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:913-894-1174
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist