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NPI Code Detail

MEDICARE: MARY ANN BENNINGTON M.A., CCC-SLP

MEDICARE: MARY ANN BENNINGTON M.A., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist104039TX

General Provider Information

NPI Number : 1477813863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN BENNINGTON M.A., CCC-SLP
Provider Business Mailing Address
First Line : 5435 N GARLAND AVE
Second Line : SUITE #140-525
City : GARLAND
State : TX
Zip : 75040-2785
Country : US
Telephone Number : 214-605-9755
Fax Number :
Provider Business Practice Location Address
First Line : 1700 N WASHINGTON ST
Second Line :
City : PILOT POINT
State : TX
Zip : 76258-3716
Country : US
Telephone Number : 940-686-5556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 05/21/2012

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