MEDICARE: MRS. CLARICE M BENJAMIN MS., 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	SLP2099	AZ

General Provider Information

NPI Number	:	1487799862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARICE M BENJAMIN MS., CCC/SLP

Provider Business Mailing Address
First Line	:	6238 E PALM ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1558
Country	:	US
Telephone Number	:	602-321-9959
Fax Number	:

Provider Business Practice Location Address
First Line	:	6238 E PALM ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1558
Country	:	US
Telephone Number	:	602-321-9959
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/24/2014

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