Basic Information
| Provider Information | |||||||||
| NPI: | 1225454242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENHAM | ||||||||
| FirstName: | KELSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Practice Location | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2014 | ||||||||
| LastUpdateDate: | 03/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ6362 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.