Provider Demographics
NPI:1831405844
Name:BENNETT, MELISSA W (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:W
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 MALIBU LAKE CIR
Mailing Address - Street 2:APT. 1336
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8705
Mailing Address - Country:US
Mailing Address - Phone:801-367-8922
Mailing Address - Fax:
Practice Address - Street 1:2175 MALIBU LAKE CIR
Practice Address - Street 2:APT. 1336
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8705
Practice Address - Country:US
Practice Address - Phone:801-367-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1831405844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist