Healthcare Provider Details

I. General information

NPI: 1699522250
Provider Name (Legal Business Name): DON MARIA BENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 204
AUSTIN TX
78728-6537
US

IV. Provider business mailing address

2413 BEAR CUB BND
LEANDER TX
78641-5046
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 702-541-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: