Individual
ELLEN BENETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
305 N 6TH ST, LA CONNER, WA 98257-9825
(360) 466-3171
Mailing address
21338 EGRET PL, MOUNT VERNON, WA 98274-7030
(360) 853-5002
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14285152
AMERICAN SPEECH LANGUAGE AND HEARING ASSOCIATION
WA
01
—
546105H
EDUCATION CERTIFICATE
WA
01
—
6100253
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
09/18/2020
Last updated
09/18/2020
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