Basic Information
| Provider Information | |||||||||
| NPI: | 1528133378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | CROSS | ||||||||
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| Credential: | CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 POPLAR HILL RD STE B | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577763088 | ||||||||
| FaxNumber: | 7576124499 | ||||||||
| Practice Location | |||||||||
| Address1: | 3800 POPLAR HILL RD STE B | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577763088 | ||||||||
| FaxNumber: | 7576124499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA8458 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 2202009464 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 889787500 | 05 | FL | MEDICAID |