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General NPI Number Information
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NPI Number | 1841633054
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Entity Type | Individual
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Provider Name | RAVEN BENNETT M.S., CCC-SLP,ABA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 477 WINDSOR ST SW STE 206
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City | ATLANTA
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State | GA
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Zip | 30312-2530
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Country | US
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Telephone | 251-609-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 477 WINDSOR ST SW STE 206
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City | ATLANTA
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State | GA
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Zip | 30312-2530
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 20597
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP011363
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License Number State | GA
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