Provider Demographics
NPI:1194161885
Name:BENNETT, ALICIA (MA-SLP, CCC)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA-SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33330 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6325
Mailing Address - Country:US
Mailing Address - Phone:253-945-2086
Mailing Address - Fax:253-945-2177
Practice Address - Street 1:4041 S 298TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-1581
Practice Address - Country:US
Practice Address - Phone:253-945-2507
Practice Address - Fax:253-945-2525
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60375355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist