Provider Demographics
NPI:1659594364
Name:BENNETT, SARA ANN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAK MEADOW CV
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4208
Mailing Address - Country:US
Mailing Address - Phone:870-307-3916
Mailing Address - Fax:870-994-3108
Practice Address - Street 1:2244 LEE ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7767
Practice Address - Country:US
Practice Address - Phone:870-307-3916
Practice Address - Fax:870-994-3108
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162971721Medicaid