Provider Demographics
NPI:1487799862
Name:BENJAMIN, CLARICE M (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CLARICE
Middle Name:M
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6238 E PALM ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1558
Mailing Address - Country:US
Mailing Address - Phone:602-321-9959
Mailing Address - Fax:
Practice Address - Street 1:6238 E PALM ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1558
Practice Address - Country:US
Practice Address - Phone:602-321-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist