MEDICARE: COURTNEY ANNE BENNETT-SOLSVIG MS CCC-SLP

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	2003009745	MO

General Provider Information

NPI Number	:	1407829799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ANNE BENNETT-SOLSVIG MS CCC-SLP

Provider Business Mailing Address
First Line	:	4150 LACLEDE AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63108
Country	:	US
Telephone Number	:	314-531-8148
Fax Number	:	314-531-5874

Provider Business Practice Location Address
First Line	:	4150 LACLEDE AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63108
Country	:	US
Telephone Number	:	314-531-8148
Fax Number	:	314-531-5874

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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