Healthcare Provider Details

I. General information

NPI: 1952388332
Provider Name (Legal Business Name): CAROLYN SYDNEE BENNETT MS, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WALL AVE STE 1127
OGDEN UT
84405-2014
US

IV. Provider business mailing address

266 E 3250 N
NORTH OGDEN UT
84414-1565
US

V. Phone/Fax

Practice location:
  • Phone: 801-612-0202
  • Fax:
Mailing address:
  • Phone: 801-737-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5106642-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: