Provider Demographics
NPI:1346577129
Name:BENNEFIELD, ALLYN CAY (MEDCCCSLP)
Entity Type:Individual
Prefix:
First Name:ALLYN
Middle Name:CAY
Last Name:BENNEFIELD
Suffix:
Gender:F
Credentials:MEDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-1846
Mailing Address - Country:US
Mailing Address - Phone:941-807-2863
Mailing Address - Fax:
Practice Address - Street 1:808 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-1846
Practice Address - Country:US
Practice Address - Phone:941-807-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890440500Medicaid