Individual
STACY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCC-SLP
Contact information
Practice address
2186 SMOKE STONE CIR, MARIETTA, GA 30062-6089
(678) 770-9362
Mailing address
2186 SMOKE STONE CIR, MARIETTA, GA 30062-6089
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005003
GA
Other
Enumeration date
02/05/2014
Last updated
02/05/2014
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