Provider Demographics
NPI:1437794120
Name:BENNETT, LEE ANN (BA)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 ROLLING BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4674
Mailing Address - Country:US
Mailing Address - Phone:317-332-7972
Mailing Address - Fax:
Practice Address - Street 1:10026 E 21ST ST STE 21
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-1802
Practice Address - Country:US
Practice Address - Phone:317-654-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker