Healthcare Provider Details

I. General information

NPI: 1881100543
Provider Name (Legal Business Name): SARAH ELISABETH BENNETT MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

1301 HOLLOW CREEK DR APT 3
AUSTIN TX
78704-2068
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax:
Mailing address:
  • Phone: 505-917-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number110094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: