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General NPI Number Information
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NPI Number | 1780910182
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Entity Type | Individual
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Provider Name | KIMBERLY BENTON MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 2202 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5328
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Country | US
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Telephone | 918-964-7025
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Fax | 918-964-7024
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Provider Business Mailing Address
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Address Line | 201 S NORTHPARK LN
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City | JOPLIN
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State | MO
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Zip | 64801-8426
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Country | US
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Telephone | 417-623-4313
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Fax | 417-621-0129
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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 | 2009015713
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License Number State | MO
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