NPI 1104058163 · live from the CMS NPI Registry
Jared Bennett, ccc/slp
Speech-Language Pathologist, in South Jordan, UT. National Provider Identifier 1104058163, active.
NPI record
| NPI | 1104058163 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Speech-Language Pathologist, 235Z00000X |
| Practice location | 1098 W 10550 S, South Jordan, UT 84095 |
| Practice phone | 801-253-1023 |
| Enumerated | August 10, 2009 |
| Last updated | August 10, 2009 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Speech-Language Pathologist, primary | 235Z00000X | 5223035-4102 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.