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General NPI Number Information
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NPI Number | 1235252057
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Entity Type | Individual
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Provider Name | MARY KATHERINE BENNEY D.T.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2007
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 134 E MORSE AVE
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City | BARTLETT
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State | IL
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Zip | 60103
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Country | US
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Telephone | 630-205-5120
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Fax | 630-837-7459
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Provider Business Mailing Address
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Address Line | 0N200 WINDERMERE RD UNIT 2706
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City | WINFIELD
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State | IL
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Zip | 60190-1935
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Country | US
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Telephone | 630-205-5120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | IL
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