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General NPI Number Information
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NPI Number | 1487927497
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Entity Type | Individual
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Provider Name | BETTY BENSON MACCCSP/L
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 4800 T-REX AVENUE SUITE 310
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City | BOCA RATON
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State | FL
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Zip | 33431
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Country | US
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Telephone | 800-681-2056
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Fax | 866-689-6058
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Provider Business Mailing Address
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Address Line | 3747 TIMBER CREEK COURT
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-225-8509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7904
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License Number State | MN
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