Nicole G Bennett, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3187 Issued in SC

Legal business name

NICOLE G BENNETT, LLC

Practice address

500 Barry Ave
Hampton, SC 29924-3810

Phone

(803) 686-0377

Fax

(803) 943-0706

NPI assigned

May 24, 2007

Last updated

Oct 25, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nicole G Bennett, MCD, CCC-SLPNPI 1023062437

Title

Sole Propietor

Phone

(803) 686-0377

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole G. Bennett, M.C.D, CCC-SLP

  • Speech-Language Pathologist
  • Hampton, SC
  • NPI 1023062437
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1891906798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 BARRY AVENUE",
            "city": "HAMPTON",
            "state": "SC",
            "postal_code": "29924",
            "telephone_number": "803-686-0377",
            "fax_number": "803-943-0706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BARRY AVE",
            "city": "HAMPTON",
            "state": "SC",
            "postal_code": "299243810",
            "telephone_number": "803-686-0377",
            "fax_number": "803-943-0706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE G BENNETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SOLE PROPIETOR",
        "authorized_official_telephone_number": "803-686-0377",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MCD, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "3187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3833",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Hampton, SC
• Providers in Hampton, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.