Provider Demographics
NPI:1346422623
Name:BENNETT, JANA CHRISTENSEN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:CHRISTENSEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 EDUCATION CT
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5526
Mailing Address - Country:US
Mailing Address - Phone:571-252-1011
Mailing Address - Fax:
Practice Address - Street 1:21000 EDUCATION CT
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-5526
Practice Address - Country:US
Practice Address - Phone:571-252-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MA1969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist