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General NPI Number Information
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NPI Number | 1992415319
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Entity Type | Individual
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Provider Name | ANTONETTE BENNETT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 10040 REFLECTIONS BLVD APT 106
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City | SUNRISE
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State | FL
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Zip | 33351-8306
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Country | US
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Telephone | 954-907-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 12717 W SUNRISE BLVD # 237
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City | SUNRISE
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State | FL
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Zip | 33323-0902
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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 | SA19992
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License Number State | FL
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