Provider Demographics
NPI:1386138600
Name:BENNETT, JENNIFER M (CD, HCHI)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CD, HCHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46691 CAVENDISH SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4324
Mailing Address - Country:US
Mailing Address - Phone:404-323-4504
Mailing Address - Fax:
Practice Address - Street 1:46691 CAVENDISH SQ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:404-323-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 374J00000X
CA221174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialist
No374J00000XNursing Service Related ProvidersDoula