Provider Demographics
NPI:1801917547
Name:CARISSA BENNETT, AUD, INC
Entity type:Organization
Organization Name:CARISSA BENNETT, AUD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:818-500-0662
Mailing Address - Street 1:1477 DWIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1315
Mailing Address - Country:US
Mailing Address - Phone:818-500-0662
Mailing Address - Fax:818-500-0803
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1801
Practice Address - Country:US
Practice Address - Phone:818-500-0662
Practice Address - Fax:818-500-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU759231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty