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General NPI Number Information
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NPI Number | 1801917547
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Entity Type | Organization
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Legal Business Name | CARISSA BENNETT, AUD, INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 633 N CENTRAL AVE SUITE #201
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City | GLENDALE
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State | CA
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Zip | 91203-1801
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Country | US
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Telephone | 818-500-0662
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Fax | 818-500-0803
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Provider Business Mailing Address
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Address Line | 1477 DWIGHT DR
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City | GLENDALE
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State | CA
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Zip | 91207-1315
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Country | US
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Telephone | 818-500-0662
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Fax | 818-500-0803
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARISSA DARLENE BENNETT
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Credential | AU.D.
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Telephone | 818-500-0662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU759
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License Number State | CA
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