Provider Demographics
NPI:1417563875
Name:BENNETT, KAMERON BECK (MS,SLP-CCC)
Entity Type:Individual
Prefix:MR
First Name:KAMERON
Middle Name:BECK
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MS,SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 CEDAR SPRINGS RD APT 6D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1277
Mailing Address - Country:US
Mailing Address - Phone:806-676-0704
Mailing Address - Fax:
Practice Address - Street 1:1910 MEDI PARK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2187
Practice Address - Country:US
Practice Address - Phone:806-457-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty