Provider Demographics
NPI:1386907442
Name:BENNIS, HEATHER (MS SPEC ED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BENNIS
Suffix:
Gender:F
Credentials:MS SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GRANTS PATH
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5047
Mailing Address - Country:US
Mailing Address - Phone:845-724-3987
Mailing Address - Fax:
Practice Address - Street 1:14 GRANTS PATH
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5047
Practice Address - Country:US
Practice Address - Phone:845-724-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753279174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist