MEDICARE: MRS. DEBORAH LUETKENHOELTER BENSON M.A./CCC-SLP

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	10404	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00724153	OTHER		AMERICAN SPEECH AND HEARING ASSOCIATION
2	10404	OTHER	OR	STATE OF OREGON PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1467610428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH LUETKENHOELTER BENSON M.A./CCC-SLP

Provider Business Mailing Address
First Line	:	1443 ELAINE WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-2890
Country	:	US
Telephone Number	:	541-219-6529
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 N 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9659
Country	:	US
Telephone Number	:	541-227-8307
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	01/25/2016

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Directions to “ MRS. DEBORAH LUETKENHOELTER BENSON M.A./CCC-SLP” Practice Location

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