Individual
MR. JASON D BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS-SLP
Contact information
Practice address
2131 S BUSINESS DR, SHEBOYGAN, WI 53081-5656
(920) 803-1617
(920) 803-1622
Mailing address
2131 S BUSINESS DR, SHEBOYGAN, WI 53081-5656
(920) 803-1617
(920) 803-1622
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2963-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41813000
—
WI
Enumeration date
11/19/2007
Last updated
12/12/2011
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