Individual
MRS. NICOLE G. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.C.D, CCC-SLP
Contact information
Practice address
500 BARRY AVE, HAMPTON, SC 29924-3810
(803) 943-0706
Mailing address
500 BARRY AVE, HAMPTON, SC 29924-3810
(803) 943-0706
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3187
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0515
—
SC
Enumeration date
05/20/2006
Last updated
07/08/2007
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