MEDICARE: COLEEN MARIE BENNETT M.A.,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	009601	NY

General Provider Information

NPI Number	:	1548405079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLEEN MARIE BENNETT M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	46 STERLING AVENUE.
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983
Country	:	US
Telephone Number	:	845-323-2789
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 STERLING AVE
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1915
Country	:	US
Telephone Number	:	845-323-2789
Fax Number	:

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

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	10/11/2019

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