Basic Information
| Provider Information | |||||||||
| NPI: | 1699902494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSW, MHPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VILONIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721739524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017729278 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1112 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VILONIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721739524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017729278 | ||||||||
| FaxNumber: | 5019825007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 373H00000X | N | Nursing Service Related Providers | Day Training/Habilitation Specialist | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.