Provider Demographics
NPI:1316215254
Name:BENNETT, ERIN KATE (MED-CF)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MED-CF
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 CHARLOIS BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1521
Mailing Address - Country:US
Mailing Address - Phone:336-725-0222
Mailing Address - Fax:877-725-0454
Practice Address - Street 1:185 CHARLOIS BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1521
Practice Address - Country:US
Practice Address - Phone:336-725-0222
Practice Address - Fax:877-725-0454
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist