Healthcare Provider Details

I. General information

NPI: 1104946292
Provider Name (Legal Business Name): ELLEN ELIZABETH STONE BENSON MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 CAT MOUSAM RD
KENNEBUNK ME
04043-6924
US

IV. Provider business mailing address

28 CLEARVIEW DR
GORHAM ME
04038-1353
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-3030
  • Fax:
Mailing address:
  • Phone: 207-839-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1120
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: