Basic Information
| Provider Information | |||||||||
| NPI: | 1659788289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENJAMIN | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | EDNA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24697 MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | HARRISON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480453133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864647474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44738 MORLEY DRIVE | ||||||||
| Address2: | THE CENTER FOR THERAPEUTIC LEARNING AND COMMUNICATION | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864214062 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101004399 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.