MEDICARE: AVERY ELISE BENAVIDES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	125031	TX

General Provider Information

NPI Number	:	1033043203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY ELISE BENAVIDES

Provider Business Mailing Address
First Line	:	9313 BLUEGRASS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-6233
Country	:	US
Telephone Number	:	512-484-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 HILLCREST PLAZA DR
Second Line	:	#207
City	:	DALLAS
State	:	TX
Zip	:	75230
Country	:	US
Telephone Number	:	972-387-2824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ AVERY ELISE BENAVIDES ” Practice Location

Language	Start Address	Practice Location

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