Provider Demographics
NPI:1952388332
Name:BENNETT, CAROLYN SYDNEE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SYDNEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 E 3250 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1565
Mailing Address - Country:US
Mailing Address - Phone:801-737-2513
Mailing Address - Fax:
Practice Address - Street 1:3651 WALL AVE STE 1127
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-2014
Practice Address - Country:US
Practice Address - Phone:801-612-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5106642-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist