Provider Demographics
NPI:1457842106
Name:BENNETT, HAYLEY KRISTEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:KRISTEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:BENNETT
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:423 WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2355
Mailing Address - Country:US
Mailing Address - Phone:330-317-5911
Mailing Address - Fax:
Practice Address - Street 1:423 WOLCOTT AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2355
Practice Address - Country:US
Practice Address - Phone:330-317-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist