Provider Demographics
NPI:1467685438
Name:BENNETT SPEECH THERAPY
Entity Type:Organization
Organization Name:BENNETT SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:205-345-5488
Mailing Address - Street 1:507 ENERGY CENTER BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473
Mailing Address - Country:US
Mailing Address - Phone:205-345-5488
Mailing Address - Fax:205-345-8819
Practice Address - Street 1:507 ENERGY CENTER BLVD
Practice Address - Street 2:SUITE 301WEST AL SPEECH THERAPY
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-345-5488
Practice Address - Fax:205-345-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890019070Medicaid