Provider Demographics
NPI:1174706667
Name:GRIFFIN, BENITA CECEILIA (SLPD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:CECEILIA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 ROSALIE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1788
Mailing Address - Country:US
Mailing Address - Phone:443-802-8869
Mailing Address - Fax:301-577-6941
Practice Address - Street 1:6431 ROSALIE LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1788
Practice Address - Country:US
Practice Address - Phone:443-802-8869
Practice Address - Fax:301-577-6941
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP890463-01OtherCAREFIRST BCBS
DCJ175-0033OtherCAREFIRST BCBS
MD890463-02OtherCAREFIRST BCBS