Provider Demographics
NPI:1689062382
Name:BENNION, KATELYN LEIGH (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEIGH
Last Name:BENNION
Suffix:
Gender:
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 1:9750 NW 33RD STREET
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:954-509-3776
Mailing Address - Fax:954-827-0308
Practice Address - Street 1:9750 NW 33RD STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-509-3776
Practice Address - Fax:954-827-0308
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6970235Z00000X
FLSA14302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014154900Medicaid