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General NPI Number Information
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NPI Number | 1922351907
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Entity Type | Organization
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Legal Business Name | IE PLLC
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 1909 VICTORIA PL
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City | EDMOND
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State | OK
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Zip | 73003-3865
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Country | US
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Telephone | 405-606-5768
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 VICTORIA PL
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City | EDMOND
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State | OK
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Zip | 73003-3865
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Country | US
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Telephone | 405-606-5768
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. MONICA MICHELLE BENEAR
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Credential | M.S.
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Telephone | 405-606-5768
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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 | 3032
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License Number State | OK
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