MEDICARE: KATIE HOGAN BENSON

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	SP-1252	WY

General Provider Information

NPI Number	:	1679179972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE HOGAN BENSON

Provider Business Mailing Address
First Line	:	3220 S BEAVERSLIDE DR
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-9229
Country	:	US
Telephone Number	:	772-453-4598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2951 W BIG TRAIL DR
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-9253
Country	:	US
Telephone Number	:	772-453-4598
Fax Number	:

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

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/15/2025

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Directions to “ KATIE HOGAN BENSON ” Practice Location

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