Provider Demographics
NPI:1699462069
Name:BENNETT, ALEXANDRA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2028
Mailing Address - Country:US
Mailing Address - Phone:315-813-0746
Mailing Address - Fax:
Practice Address - Street 1:3535 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-3200
Practice Address - Country:US
Practice Address - Phone:301-753-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist