Provider Demographics
NPI:1417370248
Name:BENNETT, AMY (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6158 JENNIS RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6761
Mailing Address - Country:US
Mailing Address - Phone:614-205-9080
Mailing Address - Fax:
Practice Address - Street 1:6158 JENNIS RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6761
Practice Address - Country:US
Practice Address - Phone:614-205-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP4106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist