Healthcare Provider Details

I. General information

NPI: 1346437647
Provider Name (Legal Business Name): RACHEL MAE BENAVIDEZ M. S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MAIN ST
CECILIA KY
42724-9702
US

IV. Provider business mailing address

222 W MAIN ST
CECILIA KY
42724-9702
US

V. Phone/Fax

Practice location:
  • Phone: 270-862-2808
  • Fax: 270-862-2454
Mailing address:
  • Phone: 270-862-2808
  • Fax: 270-862-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2915
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: