Provider Demographics
NPI:1437514700
Name:BENNETT, RYAN (BC-HIS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 CARRIAGE LANE CIR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5239
Mailing Address - Country:US
Mailing Address - Phone:940-642-1295
Mailing Address - Fax:
Practice Address - Street 1:803 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5805
Practice Address - Country:US
Practice Address - Phone:972-881-4327
Practice Address - Fax:972-633-2887
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80433237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist