Provider Demographics
NPI:1154096352
Name:BENNETT, MAEGAN PIERCE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:PIERCE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 VALLEY CREST RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-2059
Mailing Address - Country:US
Mailing Address - Phone:205-534-9116
Mailing Address - Fax:
Practice Address - Street 1:200 GEORGE HALL LN
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-0025
Practice Address - Country:US
Practice Address - Phone:659-215-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist