Individual
MRS. AMY DIANNE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1535 TIGER CIR, RATON, NM 87740-4300
(575) 445-3541
Mailing address
1407 SHERIDAN DR, NORFOLK, NE 68701-2149
(806) 679-5852
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2438
NE
235Z00000X
Speech-Language Pathologist
Primary
C-4803
NM
Other
Enumeration date
12/02/2010
Last updated
02/01/2021
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