Provider Demographics
NPI:1548405079
Name:BENNETT, COLEEN MARIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:MARIE
Last Name:BENNETT
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 1:46 STERLING AVENUE.
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983
Mailing Address - Country:US
Mailing Address - Phone:845-323-2789
Mailing Address - Fax:
Practice Address - Street 1:46 STERLING AVE
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1915
Practice Address - Country:US
Practice Address - Phone:845-323-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist