Provider Demographics
NPI:1003095985
Name:LEBRON, ANNA MARIA BENITEZ (MS-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNA MARIA
Middle Name:BENITEZ
Last Name:LEBRON
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PERKINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:575-526-6682
Mailing Address - Fax:575-523-7254
Practice Address - Street 1:301 PERKINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3248
Practice Address - Country:US
Practice Address - Phone:575-526-6682
Practice Address - Fax:575-523-7254
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist