Provider Demographics
NPI:1659855906
Name:BENNETT, ASHLEY ROSS (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSS
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:SARAH
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11306 SWEET BAY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6337
Mailing Address - Country:US
Mailing Address - Phone:864-915-5544
Mailing Address - Fax:
Practice Address - Street 1:11306 SWEET BAY CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6337
Practice Address - Country:US
Practice Address - Phone:864-915-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist