MEDICARE: BETH BENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	05447	MD

General Provider Information

NPI Number	:	1104281708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH BENNETT

Provider Business Mailing Address
First Line	:	347 BALLENGER CENTER DR
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2177 SWAINS LOCK CT
Second Line	:
City	:	POINT OF ROCKS
State	:	MD
Zip	:	21777-2014
Country	:	US
Telephone Number	:	301-663-5181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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Directions to “ BETH BENNETT ” Practice Location

Language	Start Address	Practice Location

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