Healthcare Provider Details

I. General information

NPI: 1437785235
Provider Name (Legal Business Name): BROOKLYN N BENSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD STE 124
MESA AZ
85206-4679
US

IV. Provider business mailing address

10122 E OSAGE AVE
MESA AZ
85212-2362
US

V. Phone/Fax

Practice location:
  • Phone: 480-389-6749
  • Fax:
Mailing address:
  • Phone: 480-740-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA111999
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP11199
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP11199
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: