Provider Demographics
NPI:1023871241
Name:BENNER, AMANDA L (HAS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:BENNER
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 OAKWOOD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2638
Mailing Address - Country:US
Mailing Address - Phone:513-668-5111
Mailing Address - Fax:513-248-0687
Practice Address - Street 1:1149 STATE ROUTE 131 STE D
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2717
Practice Address - Country:US
Practice Address - Phone:513-248-0187
Practice Address - Fax:513-248-0687
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03505237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist