Healthcare Provider Details

I. General information

NPI: 1477813863
Provider Name (Legal Business Name): MARY ANN BENNINGTON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N WASHINGTON ST
PILOT POINT TX
76258-3716
US

IV. Provider business mailing address

5435 N GARLAND AVE SUITE #140-525
GARLAND TX
75040-2785
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-5556
  • Fax:
Mailing address:
  • Phone: 214-605-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: