Individual
RAVEN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP,ABA
Contact information
Practice address
477 WINDSOR ST SW STE 206, ATLANTA, GA 30312-2530
(251) 609-1096
Mailing address
477 WINDSOR ST SW STE 206, ATLANTA, GA 30312-2530
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
20597
CA
235Z00000X
Speech-Language Pathologist
Primary
SLP011363
GA
235Z00000X
Speech-Language Pathologist
—
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Other
Enumeration date
04/08/2013
Last updated
07/24/2023
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