Healthcare Provider Details

I. General information

NPI: 1043791999
Provider Name (Legal Business Name): BRIGETTE BENEDICT M.A, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 30TH ST STE A
FARMINGTON NM
87402-8805
US

IV. Provider business mailing address

35 ROAD 3500
FLORA VISTA NM
87415-9670
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6845
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: