MEDICARE: SHOSHANA 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	SP.12033	OH

General Provider Information

NPI Number	:	1700766631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA BENNETT

Provider Business Mailing Address
First Line	:	4390 CHURCHILL BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4390 CHURCHILL BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3912
Country	:	US
Telephone Number	:	973-903-6489
Fax Number	:

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

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ SHOSHANA BENNETT ” Practice Location

Language	Start Address	Practice Location

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