Provider Demographics
NPI:1700072576
Name:BENNETT, KATHY L (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
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 1:1617 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2913
Mailing Address - Country:US
Mailing Address - Phone:865-982-8557
Mailing Address - Fax:865-982-8599
Practice Address - Street 1:1617 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-2913
Practice Address - Country:US
Practice Address - Phone:865-982-8557
Practice Address - Fax:865-982-8599
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP1442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist