Individual
JESSICA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
01/21/2025
Last updated
01/21/2025
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