Provider Demographics
NPI:1598046856
Name:BENNETT, JENNIFER HELEN (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HELEN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W TABERNACLE ST. #A
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-9015
Mailing Address - Fax:435-673-4016
Practice Address - Street 1:321 W TABERNACLE ST #A
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:425-432-1207
Practice Address - Fax:425-413-4465
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA 60210066237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist