Provider Demographics
NPI:1477813863
Name:BENNINGTON, MARY ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BENNINGTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 N GARLAND AVE
Mailing Address - Street 2:SUITE #140-525
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2785
Mailing Address - Country:US
Mailing Address - Phone:214-605-9755
Mailing Address - Fax:
Practice Address - Street 1:1700 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PILOT POINT
Practice Address - State:TX
Practice Address - Zip Code:76258-3716
Practice Address - Country:US
Practice Address - Phone:940-686-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist