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General NPI Number Information
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NPI Number | 1518607464
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Entity Type | Individual
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Provider Name | MELISSA GAIL BENNETT SLP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 109 EARLENE DR
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City | QUITMAN
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State | TX
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Zip | 75783-1611
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Country | US
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Telephone | 903-763-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 MALIBU LN
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City | GRAND SALINE
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State | TX
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Zip | 75140-1150
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Country | US
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Telephone | 940-597-7103
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Fax | 940-597-7103
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 101325
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License Number State | TX
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