Doctor Name: | BENJAMIN DON HAZLETT |
NPI Number: | 1619243284 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CCC-SLP |
License Number: | SLP1932 |
Business Practice Address: | 898 Sw 4th Ave Ontario, OR - 979142627 |
Business Phone Number: | 5418817330 |
Business Fax Number: | |
Mailing Address: | 1120 S Muscovy Ave, MERIDIAN |
State: | ID |
Postal Code: | 836427748 |
Phone Number: | 2089549427 |
Fax Number: | |
NPI Enumeration Date: | 03/28/2012 |
NPI Last Update Date: | 03/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP1932 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
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 |