Doctor Name: | MR. JARED BENNETT |
NPI Number: | 1104058163 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CCC/SLP |
License Number: | 5223035-4102 |
Business Practice Address: | 1098 W 10550 S South Jordan, UT - 840958597 |
Business Phone Number: | 8012531023 |
Business Fax Number: | |
Mailing Address: | 1098 W 10550 S, SOUTH JORDAN |
State: | UT |
Postal Code: | 840958597 |
Phone Number: | 8012531023 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2009 |
NPI Last Update Date: | 08/10/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5223035-4102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |