Provider Demographics
NPI:1902332760
Name:BENNETT, LEAH CATHERINE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:CATHERINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S WILSON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5082
Mailing Address - Country:US
Mailing Address - Phone:605-725-3900
Mailing Address - Fax:
Practice Address - Street 1:506 S WILSON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5082
Practice Address - Country:US
Practice Address - Phone:605-725-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant