Organization
NICOLE G BENNETT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE G BENNETT MCD, CCC-SLP (SOLE PROPIETOR)
(803) 686-0377
Entity
Organization
Contact information
Practice address
500 BARRY AVE, HAMPTON, SC 29924-3810
(803) 686-0377
(803) 943-0706
Mailing address
500 BARRY AVENUE, HAMPTON, SC 29924
(803) 686-0377
(803) 943-0706
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3187
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3833
—
SC
Enumeration date
05/24/2007
Last updated
10/25/2007
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