Provider Demographics
NPI:1558094730
Name:BENNION, MARTELL (SLP MA-CCC)
Entity Type:Individual
Prefix:
First Name:MARTELL
Middle Name:
Last Name:BENNION
Suffix:
Gender:M
Credentials:SLP MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 EAST BRIGHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-673-1557
Mailing Address - Fax:
Practice Address - Street 1:951 E BRIGHAM RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8454
Practice Address - Country:US
Practice Address - Phone:435-673-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109875-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist