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Individual

DR. JEANNE MARIE BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
1169 EASTERN PKWY STE 2238, LOUISVILLE, KY 40217-1444
(502) 376-7552
(502) 425-5540
Mailing address
9012 WILLOW SPRINGS DRIVE, LOUISVILLE, KY 40242-7763
(502) 376-7552
(502) 425-5540

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1034
KY
103G00000X
Clinical Neuropsychologist
Primary
129055
KY
103TC0700X
Clinical Psychologist
1034
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000376778
ANTHEM
KY
01
7020285
AETNA
KY
05
89000061
KY
Enumeration date
07/02/2005
Last updated
09/01/2017
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