Healthcare Provider Details

I. General information

NPI: 1285571182
Provider Name (Legal Business Name): HAILIE BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BRENNEN DR
NEWARK DE
19713-3906
US

IV. Provider business mailing address

328 BOGHT RD
WATERVLIET NY
12189-1105
US

V. Phone/Fax

Practice location:
  • Phone: 518-419-7139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO1-0012569
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: